COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


_^  HX64115577 

RA643.N48  Hand  book  of  informa 


HAND   BOOK 


OF  THE 


iiureau  of  Infectious  Diseases 


1914 


DEPARTMENT  OF  HEALTH 

OF 
THE  CITY  OF  NEW  YORK 


RECAP 


Co0ege  of  3l^l)v^itmn^  anb  ^uvQtom 


Hand  Book  of  Information 


REGARDING   THE  ^ 

-  > 

ROUTINE  PROCEDURE 


OF  THE 


BUREAU  OF  INFECTIOUS  DISEASES 


1914 


JOHN  S.  BILLINGS,  M.  D. 

Director  of  Bureau 


DEPARTMENT   OF   HEALTH 

OF 
THE  CITY  OF  NEW  YORK 

|08  L— 1914  22-520, '14,  2,000  (P) 


KA 


H^% 


TABLE  OF  CONTENTS 

Section  Page 

Functions  of  Bureau ". 1  1 

diebctobt   of   offices^   clinics,    liaboeatobiesj 

Camps,  Sanatoria  and  Maps 2  2 

Organization  of  Staff  of  the  Bureau 3  12 

Sanitary  Supervision  of  Infectious  Diseases..  18 
Authorization  by  Sanitary  Code — • 

(a)  Requiring  Notification  by  Physicians ... .     4  18 

1.  Contagious   19 

2.  Communicable    19 

3.  Indirectly  Communicable 19 

(b)  Requiring  Notification  by  Institutions. . .  20 

1.  Communicable    20 

2.  Parasitic  Diseases  of  the  Skin 20 

(c)  Requiring  Reports  of  Deaths 20 

(d)  Requiring    Notification    by    Hotels    and 

Lodging  Houses    21 

(e)  Requiring  Notification  by  Laymen 21 

(f)  Requiring  Tuberculosis  Reports  from  In- 

stitutions      22 

(g)  Requiring  Reports  of  Removal  of  Tenants  22 

(h)  Authorizing  Removal  to  Hospital 23 

(i)     Prohibiting  Removal  of  Cases 23 

(j)    Exclusion   from   School    23 

(k)  Requiring    Isolation   Facilities   in    Insti- 
tutions      24 

(1)    Burial    Regulations    in    Infectious    Dis- 
eases      25 

(m)  Requiring  Private  Funerals  in  Infectious 

Diseases    26 

(n)   Requiring  Burial  within  24  hours 26 

(o)   Requiring     Disinfection     in     Infectious 

Diseases    27 

(p)  Authorizing  Renovation  of  Premises....  27 

(q)  Requiring  Notification  of  Glanders 27 

(r)  Requiring  Destruction  of  Glandered  Ani- 
mals     27 

(s)  Requiring  Tagging  of   Dead  Horses 28 

(t)  Authorizing   Destruction   of   Rabid   Ani- 
mals and  Vicious  Dogs    28 

(u)   Forbidding  Spitting  on  Sidewalks,  etc..  29 

t 


Regulations  Applying  to  All  Employees —  Section  Page 

Temporary   Appointments    5  30 

Examination  of  New   Employees 6  31 

Probation  Period   7  31 

Forbidding  Fees 8  31 

Absences  from   Duties    9  31 

Absence  with  Pay 10  32 

Notifications  of  Absence 11  35 

Vacations    12  35 

Hours  of  Duty 13  35 

Daily  Reports  and  Time  Records 14  36 

Completion  of  Daily  Business   15  37 

Iiiformation  for  Public   16  37 

Telephone  Regulations   17  37 

Care  of  Department  Property 18  38 

Violation  of  Sanitary  Code 19  39 

Smoking    20  39 

Knowledge  of  Regulations  21  40 

Regulations  Applying  to  All  Officers — 

Monthly   Conferences    22  40 

Correspondence  and  Reports   23  40 

Central  Filing  Bureau 24  41 

General    Duties    25  42 

Special  Duties    26  42 

(a)  Director    42 

(b)  Chiefs  of  Division 43 

(c)  Borough   Chiefs    43 

(d)  Physicians  in  Charge 44 

Regulations  Applying  to  Field  Workers — 

Daily   Reports    27  44 

Search  for  New  Cases 28  4.5 

Badges    29  4r> 

Personal  Attention   to   Assignments 30  4r) 

Carfare  and  Telephone  Bills 31  4t» 

Routine  Procedure — Executive  Office — 

Duties  of  Chief  Clerk    32  41  - 

Reports    33  47 

Office  of  Supplies    34  4£ 

Records,    Blanks,    etc.    35  4P 

Efficiency  Ratings    36  4S 

ii 


INFECTIOUS  DISEASES 

General  Pbocedubb —                                          Section  Page 

Borough  Offices 37  51 

Notification  op  Infectious  Diseases 38  51 

(a)  By  Private  Physicians   51 

(b)  By  Institutions    52 

(c)  By  Death  Certificates   52 

(d)  By  Complaints    52 

(e)  By  Nurses,  Charity  Organizations,   etc..  53 

Registration  of  Infectious  Diseases 39  53 

Records  at  Borough  Offices 40  53 

(a)  General    Envelope    Name- Pile    of   Active 

Cases 54 

(b)  House-File    54 

(c)  Laboratory  File  for  Diphtheria 55 

(d)  Laboratory  File  for  Typhoid  Fever.  ...  55 

(e)  Card  Name-File  for  Tuberculosis 56 

(f)  Name-FOes   of    Terminated    Cases 56 

(g)  Report    Postal    Address    File    for    Minor 

Contagious  Diseases    56 

(h)   "Not  Found"   File  for  Tuberculosis....  56 

(i)    Name-File  of  Dead  Tuberculosis  Cases..  56 

Branch  Offices   41  56 

Branch  Office  System  of  Registration 42  57 

Records  at*  Branch  Offices   48  57 

(a)  General  Name-File  of  Contagious  Cases.  58 

(b)  General    Date    Tally-File    of    Contagious 

Cases    58 

(c)  Envelope  Name-File  for  Tuberculosis...  58 

(d)  House-File  for  Tuberculosis    58 

(e)  Date  Tally-File  for  Tuberculosis 58 

(f )  Envelope    Name  -  File     for    Tuberculosis 

(Discontinued  Cases) 58 

General  Procedure  at  Branch  Offices 44  58 

Tally  or  "Tickler"  Files 45  59 

Tally  Sheets  and  Weekly  Reports 46  59 

Daily  Report  to  Borough  Office 47  60 

DIVISION  OF  CONTAGIOUS  DISEASES 48  60 

Chief  of  Division 49  61 

Chief  Diagnostician — Duties   50  61 

Borough  Diagnostician — Duties   51  61 

111 


Section  Page 

District  Diagnostician — Duties 52           62 

(a)  District  Duty   62 

(b)  ImmuBization   62 

(c)  Removal  to  Hospitals   63 

(d)  Diagnosis    63 

(e)  Investigation  of  Meningitis  and  Anterior 

Poliomyelitis    63 

(f)  Investigation  of  Absences  of  Employees.  63 

(g)  Special  School  Certificates 63 

Instructions  for  Nurses — 

On  First  Visit   53           63 

On   Revisits    54           65 

On  Final  Visits 55           65 

General  Instructions  for  Nurses 56           66 

Notification  and  Registration 57          66 

Sanitary  Supervision — 

Inspection  of  Cases    58           67 

Classification  of  Cases    59           67 

(a)  Supervision  Cases    67 

(b)  Observation  Cases   67 

Placarding    60           68 

Quarantine    61           68 

Charitable  Assistance  and  Education  of  Pub- 
lic      62           68 

Enforced  Removals  to  Hospital 63           69 

Termination  of  Cases 64           70 

Deaths  from   Infectious  Diseases 65           70 

A.  Procedure  in  Bureau  of  Records 7G 

B.  Procedure   in   Bureau   of    Infectious    Dis- 

eases      71 

C.  Duties  of  Investigator    72 

D.  Regulations    regarding    Bodies    Removed 

from  City    

"Not  Found"  Cases  66 

Exclusion  from  School 67 

Permits  to  Return  to  School 68 


Peocedtjre    in    the    Various    Contagious    Dis- 
eases—                                                               Section  Page 
Smallpox,  Cholera,  Plague,  Yellow  Fever  and 

Typhus  Fever 69  74 

Management  of  Smallpox  by  the  Department 

of  Health    70  74 

Duties   of   Diagnosticians,    Smallpox 71  75 

Cholera,  Plague  and  Yellow  Fever 72  77 

Typhus  Fever 73  77 

Diphtheria    74  77 

Diphtheria  Antitoxin    75  78 

Diphtheria  Antitoxin  in  Syringe  Containers, — 

All-Night    Stations    76  79 

Termination  of  Cases  of  Diphtheria 77  79 

Diphtheria  Carriers    78  80 

Scarlet  Fever    79  80 

Measles    80  80 

Social  Service,  Hospital  Convalescents 81  81 

Cerebro-Spinal  Meningitis   82  82 

Acute  Poliomyelitis    83  83 


MINOR  CONTAGIOUS  DISEASES— GENERAL  PRO- 
CEDURE 

German    Measles,    Mumps,    Chickenpox    and 

Whooping  Cough   84  84 

German  Measles   85  84 

Mumps    86  84 

Chickenpox  87  84 

Whooping      Cough — Incubation      Period      and 

Quarantine    88  85 

Whooping  Cough — Management 89  85 

Other  Infectious  Diseases — 

Tetanus,    Anthrax,    Glanders,    Leprosy    and 

Trichinosis    90  86 

Malarial  Fever,  Erysipelas  and  Pneumonia. .   91  86 

Deaths  from  Malaria   92  86 

Erysipelas    93  86 

Disinfection 94  87 

Requests  for  Disinfection    95  87 

Diseases  In  which  Disinfection  is  Performed.   96  87 

Disinfection  of  Books 97  88 


Section  Page 
Methods  op  Disinfection  98  89 

(a)  Paraformaldehyde    90 

(b)  Liquid  Disinfectants 91 

Disinfection  Tests   99  92 

Duties  of  Disinfectors   100  92 

Duties  of  Disinfectors-in-charge   101  94 

Duties  of  Goods  Wagon-Drivers   lCn2  95 

Ambulance  and  Wagon  Service — 

Stables ;   Disinfecting  Plant    103 

Ambulance  Service    104 

Removal  of  Patients 105 

Vehicle  Sign 106 

Duties  of  Ambulance  Drivers  107 

Stables — 

Duties  of  Foreman  in  charge  of  Stable 108 

Duties  of  Stablemen   109 

Wagon  Service 110 

Disinfection  Plants Ill 

Duties  of  Disinfector-in-charge 112 

Rules  for  Drivers  of  Goods- Wagon 113 

Express     Service     of     the     Department     of 
Health    114 

DIVISION  OF  INSTITUTION  INSPECTION— 

Functions    115 

Regulations  for  the  Management  of  Infectious 

Diseases  in  Institutions 116 

Isolation    117 

Removal  to  Hospitals  118 

Quarantine    119 

(a)  Hospitals    

1.  Diphtheria    

2.  Scarlet  Fever 

3.  Measles    

4.  Smallpox 

(b)  Institutions    

1.  Diphtheria   

2.  Scarlet  Fever    

3.  Measles    

4.  Smallpox    

(e)  Nurseries  and  Day   Camps 

Chief  of  Division 120 

vi 


Division  of  Institution  Inspection — (Continued) 

Skction  Page 

Supervision  of  Institutions 121  107 

Notification    122  10*8 

Registration    123  109 

Office  of  Division  of  Institution  Inspection.  .124  109 

Assignment  of  Cases 125  110 

Duties  of  Institution  Inspectors 126  110 

DIVISION  OF  TUBERCULOSIS 127  113 

Organization    128  113 

(a)  Chief  of  Division 113 

(b)  Borough  Offices 113 

(c)  Branch   Offices    113 

(d)  Clinics  and  Clinic  Districts 114 

(e)  Clinic   Auxiliaries    114 

(f)  Local  Clinic  Relief   Committees 114 

(g)  Tuberculosis    Hospital   Admission   Bu- 
reau      114 

(h)  Tuberculosis  Day  Camps   114 

Notification  and  Registration 129  114 

Procedure  at  Branch  Office   130  115 

Current  Record  File  131  115 

General  Routine 132  IIG 

Monthly  Census   133  117 

Report  to  Hospital  Admission  Bureau 134  117 

Classification  of  Cases   135  118 

Class        I.  Cases   Under  the  Care  of  Pri- 
vate Physicians    136  118 

Class      II.  A.  Cases  Reported  by  non-De- 
partment Tuberculosis  Clin- 
ics in  their  Own  District. .  .137  119 
B.  Cases  Attending  Other  Clin- 
ics      120 

Class     III.  Cases  Admitted  to  Hospital. .  .138  120 
Class     IV.  Cases     Leaving     City     Tempo- 
rarily— Entering   Sanatoria.  139  121 
Class       V.  Cases    not    Found    at    Address 

Given 140  121 

Class      VL  "At   Home"    Cases 141  122 

Dead  Cases  142  122 

Recovered  Cases 143  123 

Cases  Leaving  the  City  Permanently 144  124 

vii 


Division  of  Tuberculosis — (Continued) — ■      Section  Page 

Undiagnosed  Clinic   Cases 145  124 

Scliool  Children   146  124 

Cases  Reported  as  Living  in  Other  Boroughs.  147  125 

Suspected  Cases  and  Complaints 148  126 

Investigation   of    Suspected   Cases   and   Com- 
plaints    149  127 

Recommendation  for  Charitable  Aid 150  127 

Recommendation  for  Hospital  Care 151  128 

Supervision  of  Families  of  Cases  in  Hospital.  152  128 

Sanitary  Supervision  of  Tuberculosis — 

Disinfection 153  128 

Kinds  of  Disinfection  Ordered   154  128 

Renovation    155  129 

Scrubbing  of  Floors  and  Woodwork 156  130 

Placards    157  131 

Voluntary  Renovation 158  131 

Cleaners  and  Scrubwomen   159  132 

Forcible    Removal    of    Cases    of    Pulmonary 

Tuberculosis    160  132 

Supervision  of  Cases  at  Their  Homes — 

General  Procedure 161  133 

Circulars  of  Instruction 162  134 

Description  of  Nurses'  Work  in  Homes 163  135 

Duties  of  District  Nurses  in  Clinics 164  136 

History   Cards    165  136 

District  Work  of  Clinic  Physicians 166  137 

Tuberculous  Children    167  137 

Visits  to  Lodging  House  Patients 168  138 

Visits  to  Clinic  Patients    169  138 

Recovered    Cases    170  138 

Information  for  the  Public  Regarding  Super- 
vision OF  Tuberculosis    (Circulars^ 171  139 

Moving  Picture  and  Stereopticon  Exhibitions.  172  140 

Care  of  Department's  Tuberculosis  Patients — 

The  Tuberculosis  Hospital  Admission  Bureau. 173  140 

Institutions  Admitting  Through  Bureau 174  141 

Applications  for  Admission   175  142 

System  of  Registration    176  142 

Examination  at  Admission  Bureau    177  143 

Visits  by  Physicians  for  Diagnosis   178  143 

viil 


Care  of  Department's  Tuberculosis  Patients — 

(Continued) — •                                               Section  Page 
Investigation  of  Home  and  Financial  Condi- 
tions     179  143 

Admission  to  Hospital    180  144 

Home   Conditions   after  Admission 181  144 

Supervision   of   Family   While    Patient   is   in 

Hospital    182  145 

Reports    from    Institutions    Regarding    Their 

Patients    183  145 

Home  Conditions  of  Riverside  Cases 184  145 

Sanatorium  Applicants   185  146 

Bureau  of  Information 186  147 

Tuberculosis      Preventorium      for      Children, 

Farmingdale,  N.  J 187  147 

Tuberculosis  Institutions  Maintained  by  the 
Department  of  Health — 

Riverside  Hospital 188  150 

Otisville  Sanatorium   189  150 

Instructions  for  Applicants   190  151 

Tuberculosis  Camps  and  Fresh  Air  Schools..  191  152 

A.  The  Middletown    152 

B.  The  Rutherford    152 

Routine  Procedure  192  152 

Tuberculosis  Camp  Nurses 193  153 

Tuberculosis  Camp  Regulations 194  153 

Tuberculosis  Clinics  195  157 

Objects  of  Establishment 196  157 

Clinic  Staff   197  158 

Physician-in-charge  of  Clinic 198  159 

Organization   199  159 

Furniture,  Signs,  Maps,  etc 200  160 

Forwarding  of  Reports 201  161 

Daily  Reports  to  and  from  the  Branch  Office. 202  161 

Reports  to  Headquarters   203  162 

Tabulation  of  Statistics  204  162 

Routine  Procedure 205  162 

Instructions  for  History  Taking   206  163 

System  of  Filing  Histories    207  167 

Applicants  Living  in  other  Clinic  Districts.  .208  168 

Non-Tuberculous   Applicants    209  168 

Examination  of  Bakers    210  168 

iz 


TuBBECDLosis  CLINICS — (Continued) —             Section  Paqb 
Examination    of    Applicants    for     Peddlers' 
License    211 

(a)  To  peddle    

(b)  To  maintain  stands — fruits,  etc. . . . 

(c)  To  maintain  stands — ^newspapers. . . 

(d)  To  maintain  stands — hackdrivers. . . 

(e)  Porters    

Recommendations  for  Hospital  Care 212 

Sputum  and  Urine  Specimens   213 

Reporting  of  New  Cases 214 

Deaths   215 

Procedure  In  Examination  Rooms 216 

System  of  Abbreviations    217 

Confirmatory  Re-Examinations    218 

Instructions  of  Patients  (Circular) 219 

Medicines    220 

Throat  Examinations    221 

Home  Visits  by  Nurses 222 

Delinquent  Cases   223 

Study   of  Cases    224 

Final  Diagnosis — Later  Examinations 225 

Charitable  Aid   226 

Clinic  Relief  Committees   227 

Home  Visits  by  Clinic  Physicians 228 

Milk  and  Eggs 229 

Rules  for  Attending  Physicians   230 

Volunteer  Attending  Physicians   231 

Appointment  and  Promotion  of  Volunteer  At- 
tending Physicians    232 

Clinic  Nurses    233 

Rules  for  Clinic  Nurses   234 

Circular  of  Information 235 

The  Women's  Auxiliary  to  the  Tuberculosis 

Clinics  of  the  Department  of  Health 236 

The  Association  of  Tuberculosis  Clinics 237 

DIVISION  OF  TYPHOID  FEVER 238 

Chief  of  Division 239 

Office  of  Chief  of  Division 240 

Typhoid  Charts  and  Tabulations   241 

Mapping  of  Cases  242 

X 


Division  of  Typhoid  Fevbe — (Continued)—   Section  Page 
Typhoid  Fever  Notification  and  Registration — 

Borougli  Office   243  187 

Brancli  Offices   244  188 

Investigation  of  Milk  Stores 245  189 

Investigation     of     Cases     by     Typhoid     In- 
spectors  246  189 

Antityphoid  Immunization 247  191 

Special  Instructions  for  Typhoid  Inspectors.  .248  192 

Disinfection   249  193 

Quarantine 250  193 

DIVISION  OF  NURSING— 

Superintendent  of  Nurses   251  194 

Supervising  Nurses   252  194 

Registration  and  Clinic  Nurses 253  195 

District  Nurses    254  195 

District  Nurses'  Outfit 255  196 

General  Duties  of  District  Nurses 256  197 

Nurses'  Daily  Report   257  197 

Nurses'  Weekly   Record    258  198 

DIVISION   OF  VENEREAL  AND  VETERINARY 

DISEASES 259  198 

Chief  of  Division 260  198 

Venereal  Diseases   261  199 

Registration    262  199 

Inspection  of  Cases 263  200 

Medical  Adviser 264  200 

Diagnostic  Clinics  for  Venereal  Diseases 265  201 

Serological  Laboratory 266  202 

Wassermann  Test  for  Syphilis  267  203 

Interpretation  of  the  Wassermann  Readings. 268  204 

Gonorrhoea-Complement  Fixation  Test 269  204 

Smear   Examination   for   Presence  of   Gono- 

coccl    270  205 

Symbols  Used  in  Reporting  Results  of   Ex- 
amination of  Gonococcus  Smears 271  205 

Treponema   Pallidum   Examination    272  205 

Advertising  Venereal  Quacks   273  206 

Circulars  of  Information   274  206 

zl 


Section  Page 

Glanders  275         207 

General  Procedure — ■ 

Notification   276 

Registration   277 

Investigation    278 

Disinfection  of  Stables  after  Glanders 279 

Rabies — 

General  Procedure 280 

Notification  and  Registration 281 

Investigation    282 

Clinics     for    Administration     of     Anti-Rabic 
Treatment   283 

DIAGNOSIS  LABORATORY— 

Scope  of  Work 284 

Hours  of  Examination    285 

Routine  Procedure 286 

Duties  of  the  Assistant  Director 287 

Circulars  of  Information   288 

Diphtheria — 

Outfits  for  Obtaining  Cultures 289 

Preparation  and  Examination  of  Cultures . . .  290 

Abbreviations  of  Results    291 

Test  for  Virulence 292 

Sterilization    of    Cultures    and    Storage    of 

Slides 298 

Recording  and  Reporting  of  Results 294 

Culture  Lists   295 

Routine  Procedure  In  Borough  Offices 296 

Cultures  from   School   Children 297 

Cultures  from  Department  Hospitals 298 

Examinations  on  Sundays  and  Holidays ....  299 
Preparation  of  Diphtheria  Culture  Media... 300 
Circular  of  Information 301 

Tuberculosis,    Typhoid    (Widal,    Diazo),    Ma- 
laria, Meningitis — 

General  Procedure 302 

Tuberculosi  s — 

Sputum  Outfits 303 

Method  of  Preparation,  Examination  and  Re- 
porting     304 

Antiformin  Method 305 

Reports 306 

zU 


Typhoid  Fbvee —                                               Section  Page 

Widal  Reaction  Outfit    307  226 

TechnJc  of  Examination   308  226 

Ehrlich's  Diazo  Reaction  Outfit   309  227 

Technic  of  Examination 310  227 

Circular  of  Information   311  227 

Examination  for  Malarial  Organisms 312  228 

Cbrebro-Spinal  Meningitis   313  228 

Collection  of  Specimens  and  Supervision  of 
Supply  Stations — 

Supply  Stations  314  229 

Stock  of  Supplies  Carried  by  Stations 315  230 

Duties  of  Collectors 316  231 

General  Rules  of  Diagnosis  Laboratory 317  233 

Collection  Routes — Manhattan    318  235 

Collection  Routes — ^Bronx    319  239 

Collection  Routes — ^Broolslyn   320  240 

Collection  Routes — Queens    321  244 

Collection  Routes — Richmond    322  246 

LIST  OF  PUBLICATIONS,  BLANK  FORMS,  ETC.323  247 
Forms   of   Other  Bureaus   Also   Used   in   the 

Bureau 324  262 

INDEX 263 


ziU 


HAND  BOOK  OF  INFORMATION  REGARD- 
ING THE  ROUTINE  PROCEDURE 


OF    THE 


BUREAU  OF  INFECTIOUS  DISEASES  OF  THE 

DEPARTMENT  OF  HEALTH,  CITY 

OF  NEW  YORK 


FUNCTIONS  OF  BUREAU. 

Sec.  1.  Tlie  Bureau  of  Infectious  Diseases  exer- 
nses  the  following  functions  throughout  the  Greater 
I)ity  of  New  York: — 

i   1.    The   general   sanitary   supervision   of   all   infec- 
|ious  diseases,  including: 

A.  The  acute  contagious  diseases  (Scarlet  Fever, 
Diphtheria,  Measles,  etc.)  together  with  the  disin- 
ection  of  goods  and  premises,  the  removal  of  patients 
0  Department  Hospitals,  immunization  against  Diph- 
heria  and  conducts  Whooping  Cough  Camps  and 
Jlinics. 

B.  Tuberculosis,  conducting  Tuberculosis  Hospital 
admission  Bureau,  the  Tuberculosis  Clinics  and  the 
'oat  Camps. 

'''.    Typhoid  Fever,  with  the  performance  of  immu- 
ization  against  that  disease,   Cerebro-spinal  Menin- 


gitis,  Acute  Poliomyelitis,  Malarial  Fever,  and  other 
communicable  diseases. 

D.  The  Venereal  and  Animal  diseases,  Glanders, 
and  Rabies,  conducting  the  Serological  Laboratory,  the 
Wassermann  Clinics,  and  the  Clinics  for  the  Pasteur 
treatment  of  Rabies. 

ii.  The  Bureau  also  conducts  the  Diagnosis  Lab- 
oratory, the  work  of  which  comprises:  (a)  diagnostic 
examinations  of  specimens  submitted  by  physicians; 
(b)  the  preparation  of  diagnostic  outfits,  and  (e)  col- 
lection of  specimens  and  supervision  of  supply  stations 
in  all  Boroughs. 

DIRECTORY    OF    OFFICES,    CLINICS,    LABORA- 
TORIES.   ETC. 

Sec.  2.  The  offices  of  the  Bureau  of  Infectious  Dis- 
eases are  located  as  follows: 

EXECUTIVE  OFFICES,  Centre  and  Walker  Streets, 
Tel.  6280  Franklin. 

BOROUGH   OFFICES. 

MANHATTAN  Main  Borough  Office,  Centre  and 
Walker  Sts.,— Tel.  6280  Franklin. 

BRONX  Main  Borough  Office,  3731  Third  Ave.,— Tel. 
1975   Tremont. 

BROOKLYN  Main  Borough  Office,  Flatbush  Ave. 
and  Willoughby  St.,— Tel.  4720  Main.  | 

QUEENS  Main  Borough  Office,  374  Fulton  St., 
Jamaica, — ^Tel.  1200  Jamaica. 

RICHMOND  Main  Borough  Office,  Bay  Street, 
Stapleton, — ^Tel.  440  Tompkiusvllle. 


II 


BRANCH  OFFICES. 
MANHATTAN— BRANCH  OFFICES : 

331  Broome  St.— Tel,  8859  and  7914  Orchard. 
Ill  E.  10th  St.— Tel.  2859  and  8144  Orchard. 
229  E.  57th  St.— Tel.  1637  and  2526  Plaza. 
420  E.  116th  St.— Tel.  2375  and  828  Harlem. 
2228  Broadway— Tel.  4408  Schuyler. 
307  W.  33rd  St.— Tel.  3471  and  1394  Greeley. 
22  Vandam  St.— Tel.  412  Spring. 

BRONX— BRANCH  OFFICE: 
493  East  139th  St.— Tel.  5702  Melrose. 

BROOKLYN— BRANCH  OFFICES : 

306  South  5th  St.— Tel.  886  and  1293  Williamsburg. 
60th  St.  and  2nd  Ave.— Tel.  2434  and  3988  Sunset. 
64  Penna.  Ave.- Tel.  2732  East  New  York. 
55  Sumner  Ave. — Tel.  3228  Williamsburg. 
794  West  St.— Tel.  1867  and  1866  Bath  Beach. 

QUEENS— BRANCH  OFFICE: 
110  Broadway,  Flushing— Tel.  731  Flushing. 

STABLES  AND  DISINFECTING  STATIONS. 

MANHATTAN,  Ft.  East  16th  St.— Tel.  1600  Stuy- 
i^esant. 

BRONX,  Ft.  East  132nd  St.— Tel.  4000  Melrose. 

BROOKLYN,  Kingston  Ave.  &  Fenimore  St.— Tel. 
WOO  Flatbush. 

QUEENS,  Haake  Farm— Tel.  1200  Jamaica. 

RICHMOND,  Castleton  Corners— Tel.  3.52  New  Dorp. 

3 


TUBERCULOSIS   CAMPS. 

MANHATTAN,  Day  Camp  Ferryboat  "Middle- 
to^Yn,"  Ft.  of  E.  91st  St.— Tel.  2957  Lenox. 

BROOKLYN,  Day  Camp  Ferryboat  "Rutherford," 
Ft.  of  Fulton  St.— Tel.  1530  Main. 

LABORATORIES. 

DIAGNOSIS  LABORATORY,  Centre  &  Walker 
Sts.,— Tel.  6280  Franklin. 

SEROLOGICAL  LABORATORY,  Centre  &  Walker 
Sts.,— Tel.  6280  Franklin. 

TUBERCULOSIS  CLINICS. 

All  applicants  for  diagnosis,  advice,  or  treatment 
are  referred  to  the  tuberculosis  clinic  of  the  district 

in  which  they  live. 

[Note. — All  Department  of  Health  Clinics  have 
children's  classes  from  10  A.  M.  to  noon  every  Satur- 
day.] 

MANHATTAN. 

8t.  Luke's  Hospital  Dispensary,  113th  Street  and 
Amsterdam  Avenue. — Monday,  Tuesday,  Thursday  and 
Friday,  2  to  4  P.  M. 

Harlem  Hospital  Dispensary,  136th  Street  and 
Lenox  Avenue. — Week  days,  1  to  3  P.  M. ;  Thursday, 
7  to  8  P.  M.  Children,  Tuesday  and  Saturday,  3  to  5 
P.  M. 

Vanderhilt  Clinic,  60th  Street  and  Amsterdam  Ave- 
nue.— Daily,  1  to  2.30  P.  M.  Monday,  Wednesday  and 
Friday,  9  to  10.30  A.  M.    Children,  Saturday,  2  P.  M. 


Department  of  Health,  Lower  West  Side  Clinic,  307 
1  West  33d  Street— Week  days,  2  to  4  P.  M.;  Thurs- 
day, 8  to  9  P.  M.     Children,  Saturday,  10  A.  M.  to 
I  12  M. 

,  New  York  Hospital,  Out  Patient  Department,  8  West 
16th  Street.— Monday  and  Friday,  2  to  3  P.  M. ;  Tues- 

I  day  and  Thursday,  7  to  9  P.  M.  Children,  Wednesday, 
3  P.  M.  and  Saturday,  12  M. 

St.  Vincenfs  Hospital  Dispensary,  149  West  11th 
I  Street. — Tuesday,  Thursday  and  Saturday,  10  to  11 
!  A.  M. 

Department  of  Health,  Southern  Italian,  22  Van- 
I  dam   Street. — Week   days,   2  to  4   P.   M. ;  Thursday, 
8  to  9  P.  M.     Children,  Saturday,  10  A.  M.  to  12  M. 
A  special  guide  card  is  issued  (Form  37  L). 


New  YorJc  Dispensary,  34-36  Spring  Street. — Week 
days,  11  A.  M.  to  12.30  P.  M. 

Gouverneur  Hospital  Dispensary,  foot  of  Gouver- 
neur  Street. — Monday,  Wednesday,  Friday,  2  to  4 
P.  M. ;  Tuesday,  Thursday,  Saturday,  4  to  6  P.  M. ; 
Wednesday,  8  to  9  P.  M.  Children,  Monday,  Wednes- 
day and  Friday,  2  to  4  P.  M. 

Department  of  Health,  Corlears  Clinic,  331  Broome 
Street— Week  days,  2.30  to  4.30  P.  M. ;  Thursday,  8 
to  9  P.  M.    Children,  Saturday,  10  A.  M.  to  12  M. 

Department  of  Health,  Lower  East  Side  Clinic,  111 
East  10th  Street.— Week  days,  2  to  4  P.  M. ;  Tuesday, 
Thursday  and  Saturday,  10  A.  M.  to  12  M. ;  Thurs- 
day, 8  to  9  P.  M.  Children,  Saturday,  10  A.  M.  to 
12  M. 


Bellevue  Hospital,  Out  Patient  Department,  419 
East  26th  Street.— Week  days,  1.30  to  3.30  P.  M. 
Children,  Tuesday  and  Saturday,  1.30  to  3.30  P.  M.; 
Friday,  7  to  9  P.  M. 

Department  of  Health,  Middle  East  Side  Clinic,  231 
East  57th  Street.— Daily,  2  to  4  P.  M. 

Presbyterian  Hospital  Dispensary,  70th  Street  and 
Madison  Avenue. — Week  days,  1.30  to  3  P.  M. 

German  Hospital  Dispensary,  76th  Street  and  Park 
Avenue. — Monday,  Wednesday,  Thursday  and  Satur- 
day, 11  A.  M.  to  12  M. 

Mt,  Sinai  Hospital  Dispensary,  100th  Street  and 
Madison  Avenue. — Week  days,  10  to  11  A.  M. 

Department  of  Healthy  Harlem  Italian  Clinic,  420 
East  116th  Street.— Week  days,  10  A.  M.  to  12  M.; 
Tuesday,  Thursday  and  Saturday,  2  to  4  P.  M. ;  Tues- 
day, 8  to  9  P.  M.  Children,  Saturday,  10  A.  M.  to 
12  M. 

Flower  Hospital  Dispensary,  Eastern  Boulevard  and 
63rd  Street— Wednesday,  2.30  to  3.30  P.  M. 

THE  BRONX. 

Department  of  Health,  Northern  Clinic,  Third  Av( 
nue  and  St.  Paul's  Place. — Week  days,  2  to  4  P.  M.;' 
Thursday,  8  to  9  P.  M.  Children,  Saturday,  10  A.  M. 
to  12  M. 

Department  of  Health,  Southern  Clinic,  493  East 
139th  Street.— Week  days,  10  A.  M.  to  12  M. ;  Tuesday, 
8  to  9  P.  M.    Children,  Saturday,  10  A.  M.  to  12  M. 

6 


BROOKLYN. 

Department  of  Health,  Eastern  District  Clinic,  306 
South  5th  Street.— Daily,  2  to  4  P.  M.  Children,  Sat- 
urday, 10  A.  M.  to  12  M. 

Department  of  Health,  Germantown  Clinic,  55  Sum- 
ner Avenue. — Daily,  2  to  4  P.  M.  Children,  Saturday, 
10  A.  M.  to  12  M. 

Department  of  Health,  Brownsville  Clinic,  64  Penn- 
sylvania Avenue. — Week  days,  2  to  4  P.  M.  Children, 
Saturday,  10  A.  M.  to  12  M. 

Department  of  Health,  Bay  Ridge  Clinic,  60th  Street 
and  2d  Avenue. — Monday,  Wednesday,  Friday,  2  to  3 
P.  M. 

Department  of  Health,  Main  Clinic,  Fleet  and  Wil- 
loughby  Streets. — Week  days,  2  to  4  P.  M.  Night 
clinics  for  the  whole  of  Brooklyn,  Tuesday  and 
Thursday,  8  to  9  P.  M.  Children,  Saturday,  10  A.  M. 
to  12  M. 

Department  of  Health,  ParJcville  Clinic,  974  West 
Street.— Daily,  2  to  4  P.  M.  Children,  Saturday,  10 
A.  M.  to  12  M. 

QUEENS. 

Department  of  Health,  Flushing  Clinic,  212  Broad- 
way, Flushing. — Daily,  2  to  4  P.  M. 

Department  of  Health  Clinic,  10  Union  Avenue, 
Jamaica.— Daily,  2  to  4  P.  M.  Children,  Saturday, 
10  A.  M.  to  12  M. 


RICHMOND. 

Department  of  Health  Clinic,  Bay  Street,  Staple- 
ton.— Tuesday,  Thursday,  Saturday,  2  to  4  P.  M. 

TUBERCULOSIS  HOSPITAL  ADMISSION 
BUREAU. 

Maintained  by  tlie  Department  of  Health,  the  De- 
partment of  Public  Charities  and  Bellevue  and  Allied 
Hospitals,  426  First  Avenue.  Telephone  8667  Madison 
Square.     Hours:  9  A.  M.  to  5  P.  M. 

TUBERCULOSIS    HOSPITALS    AND    SANATORIA. 

Ray  Brook,  New  York  State  Institution,  located  in 
the  Adirondacks ;  incipient  cases  only. 

Otisville  Sanatorium  of  the  Department  of  Health, 
located  in  Orange  County;  favorable  cases  only  (first 
or  early  second  stage).  These  patients  are  sent  to 
Riverside  for  observation  before  being  admitted. 

Bedford  Hills  Sanatorium,  Westchester  County,  par- 
ticularly for  Hebrews  desiring  Kosher  food;  must  be 
residents  of  New  York  City. 

Seaview  Hospital,  Department  of  Charities,  located 
on  Staten  Island;  favorable  cases  desired.  Cases  un- 
desirable at  Otisville,  accepted  at  Seaview. 

Riverside  Hospital  of  the  Department  of  Health,  lo- 
cated on  North  Brother  Island;  principally  used  for 
detention  cases;  separate  reception  pavilions  for  Otis- 
ville patients  under  observation  and  awaiting  admis- 
sion. 

Metropolitan  Hospital  of  the  Department  of  Chari- 
ties, Blackwell's  Island;  advanced  cases. 

8 


Seton  Hospital,  Spuyten  Duyvil. 

St.  Joseph's  Hospital,  Brook  Avenue  and  143rd 
Street,  The  Bronx. 

St.  Vincent's  Hospital,  Staten  Island. 

St.  Peter's  Hospital,  Henry  Street,  Brookljm. 

Brooklyn  Home  for  Consumptives,  240  Kingston 
Avenue,  Brooklyn. 

DIAGNOSIS  CLINICS  FOR  VENEREAL  DISEASES. 

Manhattan — Centre  and  Walker  Streets.  Week  days, 
9  to  10  A.  M.;  307  West  33rd  Street,  Wednesdays,  8 
to  9  P.  M. 

Brooklyn — 29  Third  Avenue.  Week  days,  9  to  11 
A.  M. ;  Tuesdays  and  Fridays,  8  to  9  p.  m. 

CLINICS    FOR   PASTEUR   TREATMENT   OF 
RABIES. 

Manhattan — Centre  and  Walker  Streets.  Week 
days,  1  to  4  P.  M. 

Brooklyn — 29  Third  Avenue.  Week  days,  11  A.  M. 
to  2  P.  M. 

The  Bronx — ^Third  Avenue  and  St.  Paul's  Place. 
Week  days,  11  A.  M.  to  1  P.  M. 

Queens — Cases  attend  Brooklyn  Clinic. 

Richmond — Cases  attend  Manhattan  Clinic. 

Sundays  and  Holidays — Cases  from  all  Boroughs  at- 
tend Brooklyn  Clinic:  10  A.  M.  to  12  M. 


9 


Map  of  Manhattan  and  The  Beonx,  showing  Tu- 

BEECTJLOSIS   ClINIC   DISTEICTS. 


HEILTH     OEPi'!TKtNT 
B>ION«    NORTKEIIN    CLINIC 


MEilTH  OE^iRTHEHT 
BRCNXSOUTHCRM  CLINIC 


10 


I 


IMap  of  Brooklyn  and  Queens,  showing  Tubeecu- 
Losis  Clinic  Distbicts. 


FLUSHING    JjOfFMAN  '^^■^ 
1  ^BOULEVARD     '^ 

mnomcREijc/ 

<k        ^vJ>     VILLE 


dp^ 
.«^- 


JAMAICA 
2 


aV 


MAIN  "% 


S  PARKVILLE   ;S^i>^ 
6  ISY^^ 


11 


Sec.  3. 


Chart  showing  Organization  of  Bureau. 

BUREAU  OF  INFECTIOUS  DISEASES 


Chief  Clerk 

Clerk  in  Charge  of  SuppheB 


DIRECTOR 

ASSISTANT  TO  DIRECTOR 

Executive  Office 

Clerk  in  Charge  of  Employes'  Records 
Clerks 

DIVISIONS 


Stenographers 
Helpers 


Tuberculosis. 


Cliief  of  Division 
Sopeivisor  of  Clinics 


Admission  Bureau 
-in-Charge 
Inspectors 


Supervising  Nurse 

Nurses 

Clerks 

Stenographer 

Cleaners 


Contagious  Diseases. 


Chief  of  Division 

Chief  Diagnostician 

Physician-in-Oharge  of  Am- 
bulances and  Stables 

Supervising  Automobile  En- 
gineman 

Clerk 

Stenographer 


Typhoid  Fever. 


Chief  of  Division 
Chief  Clerk 
Medical    Inspec- 
tors 
Clerks 
Stenographer 


Venereal  and  Veterinary. 


Chief  of  Division 
Chief  Veterinarian 
Veterinarians 
Medical  Adviser 
Medical  Inspectors 
Hospital  Physician 
Nurses 
Chief  Clerk 
Clerks 

Stenographer 

Bacteriologist-in-Charge   of 
Serological   Laboratory 
Laboratory  Assistants 
Laborers 
Cleaners 


Institution 
Inspection. 


Nurses. 


Chief  of  Division 
Medical   Inspec- 
tors 
Clerk 


Superintendent 
Assistant  Super- 
intendent 
Clerk 


Diagnosis  Laboratory. 


Assistant  Director 

Bacteriological  Diagnosti- 
cian in  Charge  of  Labora- 
tory 

Bacteriological  Diagnosti- 
cians 

Laboratory  Assistants 

Clerks 

Laborers 

Helpers 


BOROUGH  OFFICES 


Manhattan. 


The  Bronx. 


Borough  Chief 

Borough  Diagnostician 

Chief  Clerk 

Clerks 

Stenographers 

Disinfector-in-Charge 

Disinfectors 

J'oreman  in  Charge  of  Stable 

Drivers 


AjUtomobile  Enginemen 
"ismfector-in-Charge  of  Disinfecting 

oration 


Borough  Chief 

Borough  Diagnostician 

Chief  Clerk 

Clerks 

Stenographers 

Disinfector-in-Charge 

Disinfectors 

Foreman  in  Charge  of  Stable 

Drivers 

Stablemen 

Automobile  Enginemen 


Borough  Chief 
Borough  Diagnostician 
Chief  Clerk 
Clerks 

Stenographers 
Disinfector-in-Charge 
Disinfectors 

Foreman  in  Charge  of  Stable 
Drivers 
Stablemen 

Automobile  Enginemen  _ 

Disinfector-in-Charge  of  Dism- 
fecting  Station 


Borough  Chief 

Chief  Clerk 

Clerks 

Stenographer 

Disinfeetor-in-Charge 

Disinfectors 

Foreman  in  Charge  of  Stable 

Drivers 

Stablemen 


Borough  Chief 

Clerk 

Drivers 

Laborers 

Disinfectors 


Physicians  in  Charge 
District  Diagnosticians 
aupervising  Nurses 
Nurses 


Branch  Offices  and  Clinics 

Attending  and  Assistant  Attending  Physicians 


Volunteer  Attending  Physicians 

Clerks 

Cleaners 


Day  Camps 

Physicians  in  Charge  nfplfniS 

Supervising  Nurses  ?JSmen 

Domestics 


SANITARY  SUPERVISION  OF  INFECTIOUS 

DISEASES. 

AUTHORIZATION  BY  SANITARY  CODE. 

Sec.  4.  Previous  to  May  6,  1913,  the  supervision 
exercised  by  the  Department  of  Health  over  diph- 
theria, measles,  scarlet  fever  and  other  diseases 
actively  contagious,  was  conducted  through  inde- 
pendent Divisions  of  Contagious  Diseases,  one  in 
each  Borough.  As  the  work  done  by  these  divisions 
was  similar  in  character  to  that  performed  by  the  Di- 
vision of  Communicable  Diseases,  the  Board  of  Health 
at  a  meeting  held  May  6,  1913,  adopted  a  resolution 
combining  the  two,  thus  creating  a  new  division  to  be 
known  as  the  Division  of  Infectious  Diseases.  The 
Section  of  Contagious  Diseases  continued  the  work 
of  the  former  divisions.  By  resolution  of  the  Board 
of  Health  adopted  October  28,  1913,  the  Division  of 
Infectious  Diseases  was  raised  to  the  rank  of  a 
Bureau,  and  its  former  Sections  to  the  rank  of  Divis- 
ions. 

The  Bureau  of  Infectious  Diseases  of  the  Depart- 
ment of  Health  exercises  sanitary  supervision  over  all 
infectious  diseases  (for  detailed  list,  see  Articles  1,  2 
and  3  below)  occurring  in  the  City  of  New  York,  by 
virtue  of  the  following  sections  of  the  Sanitary  Code: 

REQUIRING     NOTIFICATION    BY     PHYSICIANS. 

(a)  It  shall  be  the  duty  of  every  physician  to  re- 
port to  the  Department  of  Health,  in  writing,  the  full 
name,  age  and  address  of  every  person  suffering 
from  any  one  of  the  infectious  diseases  included  in 

18 


Llie  list  appended,  with  the  name  of  the  disease,  within 
:wenty-four  hours  of  the  time  when  the  case  is  first 
seen: 

1. — Contagious  (very  readily  communicable)  ;  Meas- 
es, rubella  (rotheln),  scarlet  fever,  small-pox,  vari- 
cella   (chicken-pox),  typhus  fever,  relapsing  fever. 

2. — Communicable:  Diphtheria  (croup),  typhoid 
'ever,  Asiatic  cholera,  tuberculosis  (of  any  organ), 
plague,  tetanus,  anthrax,  glanders,  epidemic  cerebro- 
jpinal  meningitis,  leprosy,  infectious  diseases  of  the 
3ye  (trachoma,  suppurative  conjunctivitis),  puerperal 
septicaemia,  erysipelas,  whooping  cough,  acute  ante- 
ior  poliomyelitis  (infantile  paralysis). 

3. — Indirectly  Communica'ble  (through  intermediary 
lost)  :    Yellow  fever,  malarial  fever. 

[Note. — In  this  provisional  classification  of  the  In- 
fectious diseases,  arranged  for  practical  purposes,  the 
aaost  readily  communicable  of  these  diseases,  embrac- 
ing the  exanthemata  and  typhus  fever,  have  been 
placed  in  a  group  by  themselves  and  called  contagious. 
This  has  been  done  with  a  view  to  emphasizing  a  dis- 
tinction, which  is  not  only  of  scientific  significance, 
i3ut  of  practical  importance,  in  dealing  with  the  sani- 
tary features  of  administration.  This  distinction  is 
furthermore  of  importance  because  it  avoids  the  mis- 
anderstandlng  and  alarm  frequently  caused  by  in- 
luding  In  the  same  class  the  very  readily  communi- 
able  diseases  (such  as  small-pox),  and  the  much  less 
ommunicable  diseases  (such  aa  tuberculosis),  which 
require  very  different  sanitary  measures  for  their 
2ontrol.] 

19 


REQUIRING  NOTIFICATION  BY   INSTITUTIONS 

(b)  It  sliall  be  the  duty  of  the  commissioners  oi 
managers  or  the  principal,  superintendent,  or  physi- 
cian of  each  and  every  hospital,  public  institution  oij 
dispensary,  in  this  city,  to  report  to  the  Department! 
of  Health,  in  writing,  the  full  name,  age  and  address. 
of  any  person  suffering  from  any  one  of  the  infec- 
tious diseases  included  in  the  list  appended,  with  the 
name  of  the  disease,  within  twenty-four  hours  of  the 
time  when  the  case  is  first  seen : 

A. — Communicahle:  Typhoid  fever,  influenza,  lobar 
pneumonia,  broncho-pneumonia,  infectious  diseases  ol 
the  gastrointestinal  canal  (dysentery,  cholera  morbus, 
cholera  infantum,  summer  diarrhoeas  of  infants). 

B. — Parasitic  Diseases  of  the  8km:  Scabies,  tinea 
tonsurans,  impetigo  (contagious),  favus. 

[Note. — In  this  list  of  diseases  reporting  is  required 
by  the  Department  of  Health  in  order  that  data  may 
be  obtained  for  general  and  special  investigation  of 
the  modes  and  sources  of  infection  and  as  to  the  prev- 
alence and  distribution  of  these  diseases.  The  De- 
partment of  Health  does  not  purpose  to  exercise  a 
sanitary  surveillance  in  these  cases,  but  desires  in- 
formation with  a  view  to  the  ultimate  removal  or  im- 
provement in  the  conditions  which  now  foster  them. 
Notification  is  required  in  certain  of  these  diseases 
because  of  the  liability  to  their  extension  among  the 
children  in  schools.] 

REQUIRING  REPORTS  OF  DEATHS. 

(c)  It  shall  be  the  duty  of  every  physician  to  re- 
port forthwith,  in  writing,  to  the  Department  of 
Health,  the  death  of  every  person  who  dies  from,  or 

20 


while  suffering  with,  any  infectious  disease,  and  to 
state  in  such  report  the  specific  name  and  type  of 
such  disease. 

REQUIRING    NOTIFICATION    BY    HOTELS    AND 
LODGING   HOUSES. 

(d)  It  shall  be  the  duty  of  every  keeper  of  any 
boarding  house  or  lodging  house,  and  the  proprietor 
of  every  lodging  house  or  hotel,  to  report  forthwith 
to  the  Department  of  Health  all  the  known  facts  in 
regard  to  any  person  ill,  in  any  house  or  hotel  under 
his  or  her  charge,  and  suffering  from  any  one  of  the 
following  infectious  diseases :  measles,  diphtheria 
(croup),  scarlet  fever,  small-pox,  chicken-pox,  epi- 
demic cholera,  typhus  fever,  rubella  (rotheln),  plague, 
tuberculosis  and  whooping  cough. 

REQUIRING    NOTIFICATION   BY    LAYMEN. 

(e)  It  shall  be  the  duty  of  every  person  having 
knowledge  of  the  existence  of  any  person  afflicted  with 
any  one  of  the  following  infectious  diseases :  measles, 
diphtheria  (croup),  scarlet  fever,  small-pox,  chicken- 
pox,  epidemic  cholera,  typhus  fever,  rubella  (rotheln), 
plague,  tuberculosis,  typhoid  fever  and  whooping 
cough,  who  he  has  reason  to  think  requires  the  atten- 
tion of  the  Department  of  Health,  to  at  once  report 
to  the  Department  all  facts  in  regard  to  the  disease; 
and  no  person  shall  interfere  with  or  obstruct  the  en- 
trance, inspection  or  examination  of  any  building 
or  house,  or  the  occupants  thereof,  by  the  inspectors 
and  officers  of  this  Department,  when  any  case  of 
Dne  of  the  infectious  diseases  above  specified  has  been 
rejtorted  as  existing  in  such  house  or  dwelling;  nor 
shall  any  person  interfere  with  or  obstruct,  mutilate 

21 


or  tear  down  any  notices  of  this  Department  posted 
in  or  on  any  premises  in  the  City  of  New  York. 

REQUIRING     TUBERCULOSIS     REPORTS     FROM 
INSTITUTIONS. 

(f)  It  shall  be  the  duty  of  the  commissioners  or 
managers,  or  the  principal,  superintendent  or  physi- 
cian of  each  and  every  public  or  private  institution 
or  dispensary  in  this  city  to  report  to  the  Department 
of  Health,  in  writing, — or  to  cause  such  report  to  be 
made  by  some  proper  and  competent  person, — the  name, 
age,  sex,  occupation  and  latest  address  of  every  per-; 
son  afflicted  with  tuberculosis,  who  is  in  their  care 
or  who  has  come  under  their  observation,  within  one 
week  of  such  time.  It  shall  be  the  duty  of  every 
person  sick  with  this  disease  and  of  every  person  in 
attendance  upon  any  one  sick  with  this  disease,  and 
of  the  authorities  of  public  and  private  institutions  j 
or  dispensaries,  to  observe  and  enforce  all  the  sani- 
tary rules  and  regulations  of  the  Board  of  Health 
for  preventing  the  spread  of  pulmonary  tuberculosis. 

REQUIRING   REPORTS   OF   REMOVAL   OF 
TENANTS. 

(g)  Every  owner,  lessee,  tenant  and  occupant  of 
any  dwelling  or  apartment  in  the  City  of  New  York 
shall  forthwith  report  to  the  Department  of  Health 
in  writing  the  removal  of  any  person  from  such 
dwelling  or  apartment  who  shall  be  suffering  from  any 
of  the  following  infectious  diseases:  measles,  diph- 
theria (croup),  scarlet  fever,  small-pox,  chicken-pox, 
epidemic  cholera,  typhus  fever,  rubella  (rotheln), 
plague,  whooping  cough  or  tuberculosis  (of  any  or- 
gan). 

22 


AUTHORIZING  REMOVAL  TO  HOSPITAL. 

(h)  Whenever  an  Inspector  of  this  Department 
shall  report  in  writing  that  any  person  is  sick  of  any 
infectious  disease,  nnder  such  circumstances  that  the 
continuance  of  such  sick  person  in  the  place  where  he 
or  she  may  be  is  dangerous  to  the  lives  of  other  per- 
sons residing  in  the  neighborhood,  the  Sanitary  Su- 
perintendent, an  Assistant  Sanitary  Superintendent, 
or  the  Chief  Inspector  of  the  Division  of  Contagious 
Diseases,  upon  the  report  of  the  ^Medical  Inspector  of 
the  Department,  may  cause  the  removal  of  such  sick 
person  to  one  of  the  hospitals  under  the  charge  of  this 
Department  or  to  a  Hospital  delegated  by  the  Board 
lof  Health. 

PROHIBITING  REMOVAL  OF  CASES, 
(i)  No   person   shall   within   this   city,    without   a 
'[permit  from  the  Board  of  Health,  carry,  remove,  or 
cause  or  permit  to  be  carried  or  removed,  any  per- 
'son  sick  with  any  infectious  disease,   or  remove  or 
cause  to  be  removed,  any  such  person  from  any  build- 
ing or  vessel  to  any  other  building  or  vessel  or  to  the 
shore,  or  to  or  from  any  vehicle  in  any  part  of  the 
city.     Nor  shall  any  person,  by  any  exposure  of  any 
individual  sick  of  any  infectious  disease,   or  of  the 
'  body  of   such   person,   or   by   any   negligent   act   con- 
^  nected  therewith,   or  in  respect  of  the  care  or  cus- 
"  tody  thereof,  or  by  a  needless  exposure  of  himself, 
^  ?ause  or  contribute  to,  or  promote  the  spread  of  dis- 
''  ?ase  from  any  such  person,  or  from  any  dead  body. 

EXCLUSION  FROM   SCHOOL. 
0)   No  principal  or  superintendent  of  any  school, 
ind  no  parent,  master  or  custodian  of  any  child  or 

23 


minor  (having  tbe  power  and  authority  to  prevent) 
shall  permit  any  child  or  minor  having  scarlet  fever 
diphtheria  (croup),  small-pox  or  any  dangerous,  in 
fectious  or  contagious  disease,  or  any  child  in  any 
family  in  which  any  such  disease  exists  or  has  re- 
cently existed,  to  attend  any  public  or  private  school 
until  the  Board  of  Health  shall  have  given  its  per- 
mission therefor,  nor  in  any  manner  to  be  unneces- 
sarily exposed,  or  to  needlessly  expose  any  other 
person  to  the  taking  or  to  the  infection  of  any  con- 
tagious disease. 

REQUIRING   ISOLATION   FACILITIES   IN   INSTI- 
TUTIONS. 

(k)  In  every  sanatorium,  sanitarium,  day  nursery, 
convalescent  home,  home  for  children,  reformatory, 
training  school,  boarding  school,  hospital,  and  dispen 
sary,  or  institution  for  the  care  or  treatment  of  persons 
in  the  City  of  New  York  there  shall  be  provided  and 
maintained  a  suitable  room  or  rooms  for  the  temporary 
isolation  of  persons  suffering  from  any  one  of  the  fol- 
lowing infectious  diseases :  Measles,  diphtheria 
(croup),  scarlet  fever,  small-pox,  chicken-pox,  epi- 
demic cholera,  typhus  fever,  rubella  (rotheln),  plague 
and  whooping  cough,  and  such  persons  shall  imme- 
diately be  separated  from  other  persons  at  such  dis- 
pensary or  hospital.  It  shall  be  the  duty  of  the  physi- 
cian or  physicians,  and  of  the  officers  and  managers 
of  every  hospital  or  dispensary,  to  cause  a  report  to 
be  immediately  made  to  the  Department  of  Health 
of  the  City  of  New  York  of  every  person  afflicted  with 
any  one  of  the  infectious  diseases  herein  specified  who 
comes  to  their  knowledge,  and  to  have  such  persons 

24 


properly  isolated  from  other  persons;  and  shall  also 
immediately  report  or  cause  to  be  reported  to  the  said 
Department  the  name,  age  (so  far  as  can  be  ascer- 
tained) and  residence  of  every  person  received  or 
treated  thereat  who  is  afflicted  with  puerperal  septi- 
caemia or  suppurative  conjunctivitis  and  the  name 
of  the  particular  disease  with  which  the  person  is  so 
afflicted;  and  shall  also  report  the  name  and  address 
of  the  physician  or  midwife  in  attendance  at  the  time 
of  the  onset  of  the  disease,  which  information  it  is 
hereby  made  the  duty  of  such  hospital  or  dispensary 
to  obtain  and  record  among  its  records. 

BURIAL  REGULATIONS  IN  INFECTIOUS 
DISEASES. 
(1)  It  shall  be  the  duty  of  every  undertaker  hav- 
ing notice  of  the  death  of  any  person  within  the 
City  of  New  York  of  small-pox,  diphtheria  (croup), 
scarlet  fever,  yellow  fever,  typhus  fever,  plague, 
Asiatic  cholera,  measles,  cerebro-spinal  meningitis, 
acute  poliomyelitis,  or  any  other  infectious  disease 
dangerous  to  the  general  health  of  the  community,  or 
of  the  bringing  of  the  dead  body  of  any  person  who 
has  died  of  any  such  disease  into  such  city,  to  give 

mmediate  notice  thereof  to  this  Department.  No  per* 
son  shall  retain  or  expose,  or  assist  in  the  retention 
9r  exposure  of  the   dead  body   of   any  such   person 

xcept  in  a  coffin  or  casket  properly  sealed;  nor  shall 
lie  allow  any  such  body  to  be  placed  in  any  coffin  or 
casket  unless  the  body  has  been  wrapped  in  a  sheet 

iaturated    with    a    proper    disinfecting    solution    and 

he  coffin  or  casket  shall  then  be  immediately  and  per- 
manently sealed.  No  undertaker  shall  assist  in  the 
public  or  church   funeral   of   any   such  person.     No 

25 


undertaker  shall  use,  or  cause  or  allow  to  be  used, 
at  any  funeral,  or  in  any  room  where  the  dead  body 
of  any  person  shall  be,  any  draperies,  decorations, 
rugs  or  carpets,  belonging  to  or  furnished  by  him  or 
under  his  direction. 

REQUIRING     PRIVATE     FUNERALS     IN     INFEC- 
TIOUS DISEASES. 

(m)  A  public  or  church  funeral  shall  not  be  held 
of  any  person  who  has  died  of  small-pox,  diphtheria 
(croup),  scarlet  fever,  cerebro-spinal  meningitis,  acute 
poliomyelitis,  yellow  fever,  typhus  fever,  Asiatic 
cholera,  measles  or  plague ;  but  the  funeral  of  such 
person  shall  be  private,  and  it  shall  not  be  lawful  to 
invite,  or  permit  at  the  funeral  of  any  person  who  has 
died  of  any  one  of  the  above  diseases,  or  of  any  infec- 
tious disease,  or  at  any  services  connected  therewith, 
any  person  whose  attendance  is  not  necessary,  or  to 
whom  there  is  danger  of  contagion  thereby. 

REQUIRING    BURIAL    WITHIN   24    HOURS. 

(n)  No  person  shall  ahow  to  be  retained  unburied 
the  dead  body  of  any  human  being  for  a  longer  time 
than  four  days,  or  where  death  has  resulted  from 
small-pox,  diphtheria  (croup),  scarlet  fever,  cerebro- 
spinal meningitis,  acute  poliomyelitis,  yellow  fever, 
typhus  fever,  plague,  Asiatic  cholera  or  measles,  for  a 
longer  time  than  twenty-four  hours,  after  death  of 
such  person,  without  a  permit  from  the  Sanitary 
Superintendent  or  an  Assistant  Sanitary  Superintend 
ent,  which  i)ermit  shall  specify  the  length  of  time 
during  which  such  body  may  be  retained  unburied. 

2G 


REQUIRING  DISINFECTION  IN  INFECTIOUS 
DISEASES. 

(o)  Adequate  disinfection  or  cleansing  and  renova- 
tion of  premises,  furniture  and  belongings,  deemed 
by  the  Department  of  Health  to  be  infected  by  con- 
t.-igious  or  communicable  diseases,  shall  immediately 
follow  the  recovery,  death  or  removal  of  the  person 
suffering  from  such  disease,  and  such  disinfection  or 
cleansing  and  renovation  shall  be  performed  by  the 
owner  or  occupant  of  said  premises  when  ordered  by 
the  Board  of  Health. 

AUTHORIZING  RENOVATION  OF  PREMISES. 

(p)  All  filthy  and  dirty  walls  and  ceilings  of  any 
building,  including  the  walls  and  ceiling  of  the  cellar 
thereof,  shall  be  thoroughly  cleaned  and  white- 
washed whenever  required  by  the  Board  of  Health. 

REQUIRING   NOTIFICATION   OF  GLANDERS. 

(q)  Every  veterinary  surgeon  who  is  called  to 
examine  or  professionally  attend  any  animal  within 
the  City  of  New  York  having  glanders  or  farcy 
or  any  contagious  disease,  shall  report  forthwith  in 
writing  to  tlie  Board  of  Health  of  said  city  the  fol- 
lowing facts,  \iz. :  1st,  a  statement  of  the  location 
of  such  diseased  animal;  2d,  the  name  and  address 
of  the  owner  thereof ;  3d,  the  type  and  character  of 
the  disease. 

REQUIRING  DESTRUCTION  OF  GLANDERED 
ANIMALS. 

(r)  No  person  shall  keep,  retain  or  allow,  or  cause 
to  be  kept  or  retained  at  any  place  in  the  City  of  New 
York,    any    animal    having    the    disease    known    as 

27 


glanders  or  farcy,  or  any  other  contagious  disease, 
but  shall  forthwith  report  every  such  case  and  the  lo- 
cation thereof  to  the  Department  of  Health;  the 
Sanitary  Superintendent  or  an  Assistant  Sanitary 
Superintendent  of  the  said  Department  shall  cause 
every  such  animal  to  be  destroyed  and  the  body 
thereof  removed  and  disposed  of  in  such  manner  as 
shall  be  by  him  designated. 

REQUIRING   TAGGING  OF  DEAD  HORSES. 

(s)  All  dead  horses,  before  they  are  placed  in  the 
street,  must  have  a  tag  attached  giving  the  name  and 
address  of  the  owner  and  the  stable  from  which  the 
horse  was  removed. 

AUTHORIZING    DESTRUCTION    OF    RABID    ANI- 
MALS   AND    VICIOUS    DOGS. 

(t)  Every  animal  which  shows  symptoms  of  rabies 
and  every  animal  that  has  been  exposed  to  such  dis- 
ease shall,  by  the  person  owning  the  same  or  having 
possession  thereof,  be  at  once  confined  in  some  secure 
place  for  such  length  of  time  as  to  determine  whether 
such  disease  exists  or  to  show  that  such  exposure  has 
not  given  such  animal  said  disease,  and  so  as  to  avoid 
all  danger  to  life  or  health.  And  such  person  shall 
also  forthwith  notify  the  Department  of  Health 
thereof  and  of  the  place  where  such  animal  is  con- 
fined. Every  animal  which  is  mad  or  has  rabies  shall 
at  once  be  killed  by  the  owner  or  person  having  pos- 
session thereof,  or  by  the  Department  of  Health,  and 
the  body  of  any  animal  that  has  died  of  such  disease, 
or  being  suspected  of  such  disease  has  been  killed, 
shall  be  at  once  surrendered  to  the  Department  of 
Health   to   be   by    it   disponed   of. 

28 


Should  a  dog  bite  any  person  it  shall  be  the  duty 
of  the  owner,  or  person  having  the  same  in  his  pos- 
session or  under  his  control,  to  at  once  notify  said 
Department  thereof,  and  surrender  said  dog  to  said 
Department  for  inspection  and  observation;  and  such 
dog  shall  be  returned  to  the  person  from  whom  the 
same  shall  have  been  received  if  found  not  rabid  or 
vicious,  and  if  found  to  be  rabid  or  vicious  to  such  an 
extent  as  to  be  unsafe  to  be  at  large,  it  shall  be  de- 
stroyed by  said  Department. 

When  the  police  or  other  person  or  authorities  de- 
stroy a  dog  for  any  of  the  causes  herein  mentioned, 
it  shall  be  his  or  their  duty  to  immediately  notify 
the  said  Department  thereof  and  of  the  location  of 
its  body,  so  that  the  same  may  be  obtained  by  the 
said  Department ;  and  it  shall  be  unlawful  to  remove 
any  such  dog  or  the  body  of  any  such  animal  here- 
tofore mentioned  except  as  herein  provided. 

FORBIDDING    SPITTING    ON    SIDEWALKS,    ETC. 

(u)  Spitting  upon  the  sidewalk  of  any  public  street, 
avenue,  park,  public  square  or  place  in  the  City  of 
New  York,  or  upon  the  floor  of  any  hall  in  any  tene- 
ment house  which  is  used  in  common  by  the  tenants 
thereof,  or  upon  the  floor  of  any  hall  or  office  in  any 
hotel  or  lodging  house  which  is  used  in  common  by 
the  guests  thereof,  or  upon  the  floor  of  any  theatre, 
store,  factory,  or  of  any  building  which  is  used  in 
common  by  the  public,  or  upon  the  floor  of  any  ferry- 
boat, railroad  car  or  other  public  conveyance,  or  upon 
the  floor  of  any  ferryhouse,  depot  or  station,  or  upon 
the  station  platform  or  stairs  of  any  elevated  rail- 
road or  other  common  carrier,  or  into  the  street  from 

29 


the  cars,  stairs  or  platforms  of  the  elevated  railroads, 
is  hereby  forbidden. 

The  corporations  or  persons  ovv'niug  or  having  the 
management  or  control  of  any  such  building,  store, 
factory,  ferryboat,  railroad  car  or  other  public  con- 
veyance, ferryhouse,  depot  or  station,  station  platform 
or  stairs  of  any  elevated  railroad  or  other  common 
carrier,  are  hereby  required  to  keep  permanently 
posted  in  each  of  said  places  a  sufficient  number  of 
notices  forbidding  spitting  upon  the  floors  and  calling 
attention  to  the  provisions  of  this  section. 

It  is  hereby  made  the  duty  of  every  corporation  or 
person  engaged  in  the  manufacture  of  cigars,  cigar- 
ettes or  tobacco,  or  conducting  the  business  of  print- 
ing in  the  City  of  New  York,  where  ten  or  more  per- 
sons are  employed  on  the  premises,  to  provide  proper 
receptacles  for  expectoration.  Such  receptacles  are 
to  be  in  proportion  of  one  for  every  two  persons  so 
employed,  and  they  are  to  be  cleansed  and  disinfected 
at  least  once  in  every  twenty-four  hours. 

A  copy  of  the  preceding  paragraph  must  be  kept 
posted  in  a  conspicuous  place  in  every  factory  or 
printing  office  mentioned  therein. 

REGULATIONS  APPLYING  TO  ALL  EMPLOYEES. 
TEMPORARY  APPOINTMENTS. 

Sec,  5.  Temporary  employees  appointed  because  of 
non-existence  of  Civil  Service  eligible  lists  are  ex- 
amined by  the  Civil  Service  Commission  within  fifteen 
days  after  appointment  and  if  successful  in  passing, 
continue  to  serve  until  a  new  eligible  list  is  announced. 

80 


EXAMINATION   OF    NEW   EMPLOYEES. 

Sec.  6.  All  new  employees  are  vacciDated  and  un- 
5i  dergo  a  physical  examination  when  entering  the  serv- 
i]  ice.  They  are  re-examined  and  re-vaccinated  from 
-|  time  to  time,  a  record  being  kept  of  these  exami  na- 
il tions  (Form  23  E).  Immunization  against  typhoid 
1;  fever  is  recommended. 

PROBATION  PERIOD. 

Sec.  7.  Each  employee  appointed  from  the  Civil 
Service  eligible  list  is  placed  on  probation  for  a 
period  of  ninety  days.  Reports  as  to  quality,  etc.,  of 
work  are  forwarded  by  the  superior  officer  at  the  ex- 
piration of  thirty,  sixty  and  seventy-five  days  re- 
spectively. If  unsatisfactory,  employee  must  be  so  no- 
tified. 

FORBIDDING  FEES. 

Sec.  8.  No  physician,  nurse,  or  other  employee 
of  the  Department  of  Health  is  to  accept  money  or 
other  gratuity  for  acting  in  any  ofiicial  capacity. 

ABSENCES  FROM  DUTY. 

Sec.  9.  Whenever  an  employee  is  absent,  said  em- 
ployee is  to  telephone  or  telegraph  the  fact  imme- 
diately to  the  office  of  the  superior  officer.  Within 
three  (3)  hours  a  written  notification  of  absence 
(Form  21  C)  is  to  be  forwarded,  stating  cause, — if 
illness,  its  nature  is  to  be  stated.  Every  employee  is 
expected  to  keep  on  hand  one  or  more  of  these  blanks. 
On  return  to  duty,  the  employee  is  to  report  in  person 
at  the  office  of  the  superior  officer,  where  a  written  ap- 
plication for  leave  is  to  bo  made  out  (Form  23  C)  stat- 

31 


Ing  dates  of  absence,  inclusive,  and,  if  cause  was  ill- 
ness, attaching  a  pliysician's  certificate. 

Whenever  an  employee  reports  that  he  is  unable  to 
perform  his  duties  on  account  of  "illness,"  "sickness," 
or  other  indefinite  reason,  an  immediate  investigation 
is  made  by  a  district  diagnostician  to  determine  the 
exact  nature  of  such  illness. 

Each  absent  employee  is  examined  at  least  once  each 
week  by  a  district  diagnostician,  who  reports  in  writ- 
ing the  physical  condition  and  the  reason  for  continued 
absence,  together  with  a  recommendation  that  such 
employee  immediately  report  for  duty,  if,  in  the  opin- 
ion of  the  district  diagnostician  further  absence  is 
unnecessary. 

Under  no  circumstances  may  employees,  absent 
from  duty  for  any  cause,  leave  the  city  without  a 
written  statement  of  that  intention  being  made  to  their 
superior  officer,  and  the  employees  subsequently  being 
notified  that  such  permission  has  been  given.  Per- 
mission to  leave  the  city  will  only  be  given  when  the 
employees  inform  their  superior  officer  where  they  may 
be  readily  reached  by  mail. 

ABSENCE  WITH  PAY. 

Sec.  10.  Tbis  is  granted  under  the  following  con- 
ditions : 

A. — Civil  Service  Examinations:  Absence  with  pay 
is  granted  for  attendance  at  examinations  for  promo- 
tion within  the  Department,  but  not  for  attendance  at 
examinations  for  appointment  outside  the  Department. 

B. — Conventions:  No  absence  with  pay  Is  allowed 
for  attendance  at  conventions,  except  where  it  is  as  a 

32 


representative  of  the  Department,  or  permitted  by  leg- 
islative act. 

C. — Court  Attendance:  (1)  Absence  without  pay  is 
granted  where  presence  at  court  is  required  of  a  phy- 
sician of  the  Department,  in  his  professional  capacity, 
for  pay;  (2)  absence  with  pay  is  granted  where 
presence  at  court  is  required  on  non-departmental 
business,  when  there  is  no  other  compensation  than 
that  prescribed  by  law :  (3)  absence  with  pay  is  grant- 
ed for  attendance  at  court  on  Department  business. 

D. — Deaths  in  Family:  In  case  of  death  in  imme- 
diate family  (husband,  wife,  children,  parents,  broth- 
ers or  sisters),  three  days'  absence  with  pay  is  granted. 

E. — Illness:  Absence  is  granted  with  pay  to  an  ag- 
gregate of  two  weeks  in  any  one  year  to  employees 
who  have  been  more  than  one  year  in  the  service,  and 
to  an  aggregate  of  one  day  for  each  month  of  service 
to  emplo3''ees  in  the  service  less  than  one  year.  But 
every  request  must  be  accompanied  by  a  private  phy- 
sician's or  diagnostician's  certificate. 

Absence  is  granted  with  pay  for  illness  of  more  than 
two  weeks,  but  in  no  case  for  a  period  exceeding  six 
months,  only  after  certification  by  a  family  physi- 
cian and  a  district  diagnostician  that  the  employee 
was  incapacitated  from  fulfilment  of  duties  for  the 
entire  period  of  absence.  The  Director  of  the  Bureau 
recommends  such  grant  of  pay,  and  the  recommenda- 
tion if  endorsed  by  the  Conmiittee  on  Absences  is  sub- 
mitted to  the  Board  of  Health  for  its  approval. 

The  rule  with  regard  to  absence  of  over  two  weeks' 
duration  is  not  to  apply  to  employees  of  less  than 
one  year's  standing. 

33 


F. — Military  or  11  aval  Duty, 

G. — Quarantine  tor  Infectious  Diseases. 

H. — For  Religious  Holidays:  Only  such  as  are  per- 
mitted by  the  Mayor  to  be  allowed  to  all  employees 
of  City  Departments. 

In  the  event  of  any  employee  being  entitled  to  pay 
for  only  a  part  of  the  time  of  his  absence,  it  is  neces- 
sary to  forward  two  applications,  one  for  the  time 
during  which  he  is  entitled  to  full  pay,  and  the  other 
for  the  time  without  pay. 

When  an  application  (Form  23  C)  for  a  leave  of 
absence  is  filed,  where  the  applicant  has  already  been 
absent  seven  days  from  June  1,  a  statement  must  be 
made  on  the  application,  showing: 

First.  Date  or  dates  of  absence  from  June  1  and 
reasons  for  prior  absence. 

Second.  Whether  the  prior  absence  was  granted 
with  or  without  pay. 

If  pay  is  desired,  the  employee  must  also  forward 
a  separate  formal  statement  giving  reasons  for  this 
request.  The  superior  officer  of  this  employee  on  re- 
ceipt of  this  application  and  statement,  will  endorse  it 

ns  follows: 

Name  of  employee,  Civil  Service  title,  date  of  ap- 
pointment, statement  regarding  quality  and  quantity 
of  work  performed  by  him,  and  reasons  for  approval 
or  disapproval. 

Applications  for  leave  not  accompanied  by  statement 
described  above,  are  forwarded  with  the  recommenda- 
tion that  leave  be  granted  without  pay. 

84 


I 


NOTIFICATIONS  OF  ABSENCE. 

Sec.  11.  All  notifications  of  absence  and  applica- 
tions for  leave  of  absence,  after  having  been  properly 
endorsed  by  the  official  immediately  superior  to  the 
absent  employee,  are  signed  by  the  Chief  of  Division 
or  Borough  Chief  and  forwarded  to  the  Director. 

VACATIONS. 

Sec.  12.  (a)  An  annual  vacation  of  three  weeks 
is  granted  to  each  employee,  this  to  take  efCect  for 
the  year  beginning  June  1,  1914,  therefore  to  be  oper- 
ative in  the  summer  of  1915;  (b)  one  week's  vacation 
in  addition  to  the  three  weeks  allowed  under  preced- 
ing rule  is  granted  to  every  employee  who  has  been 
in  the  Department  twenty  years  or  more. 

HOURS  OF  DUTY. 

Sec.  13.  Every  medical  inspector  is  to  give  to  the 
work  of  the  Bureau  at  least  three  and  a  half  hours 
daily,  except  on  Sundays  and  legal  holidays,  but  an 
inspector  may  be  required  to  exceed  these  hours  if 
the  necessities  of  the  service  require  it.  Nurses  de- 
vote at  least  six  hours  daily  to  their  work.  Saturday 
being  a  half  holiday  by  statute,  three  hours  constitute 
a   Saturday's  work. 

Any  employee  of  the  Department  of  Health  found  to 
have  tampered  with  the  time  clocks  located  in  the 
various  offices  of  the  Department,  or  to  have  altered 
or  falsified  the  time  cards  attached  thereto,  will  be 
subject  to  dismissal  from  the  Department  of  Health 
without  further  warning. 

All  officers  of  the  Bureau  are  charged  with  the 
aaily  inspection  before  10  A.  M.,  of  the  time  clock 

35 


cards  of  every  employee  of  the  Bureau  under  their 
supervision,  using  such  cards.  Tardiness  of  em- 
ployees is  thus  taken  up  at  once. 

Tardiness  or  absences  for  unsanctioned  causes  may 
result  in  reduction  of  pay. 

A  monthly  summary  of  time,  tabulated  from  the 
daily  reports  of  each  employee  of  the  Bureau  of  In- 
fectious Diseases  not  using  time  clock  cards  or  time 
sheets,  is  forwarded  to  the  Executive  Office  and  there 
kept  on  file. 

The  hours  of  duty  of  all  clerks,  laboratory  assist- 
ants, laborers,  etc.,  are  from  9  A.  M.  until  5  P.  M., 
but  an  employee  may  be  required  to  exceed  those 
hours,  if,  in  the  opinion  of  his  superiors,  the  neces- 
sities of  the  service  require  it.  The  luncheon  time 
of  the  clerks,  stenographers,  typists  and  all  other 
employees  on  duty  in  the  offices,  is  not  to  be  longer 
than  one  hour,  and  is  to  be  taken  only  between  the 
hours   of   12   M.   and  2   P.   M. 

DAILY  REPORTS  AND  TIME  RECORDS. 

Sec.  14.  Every  employee  of  the  Department  of 
Health  keeps  a  daily  record  of  his  hours  on  duty,  and 
nature  of  work  performed.  Clerks,  stenographers, 
and  laboratory  assistants  register  hour  of  arrival  and 
departure  daily  on  the  time  clocks  at  each  Borough 
Office.  Diagnosticians,  inspectors  and  district  nurses 
submit  a  daily  report  of  work  performed,  the  name 
and  address  of  each  case  visited,  the  hour  of  arrival 
at  the  same,  the  nature  of  the  assignment  and  the 
number  of  hours  on  duty.  All  other  employees,  with- 
out exception,  submit  the  regulation  time  sheet  (Form 
23  A),  showing  hours  on  duty,  etc.     Each  time  sheet 

36 


covers  a  period  of  ten  days,  and  is  to  be  submitted 
immediately  on  its  completion. 

Every  time  card  and  time  sheet  must  state  the  title, 
location  of  office  and  nature  of  the  duties  performed. 

Employees  who  visit  more  than  one  office  or  locality 
in  the  performance  of  their  duties,  must  state  on  the 
bacli  of  said  time  sheet  the  places  other  than  head- 
quarters visited,  and  the  time  spent  thereat.  Time 
unaccounted  for  is  supposed  to  have  been  spent  at 
headquarters. 

COMPLETION  OF  DAILY  BUSINESS. 

Sec.  15.  All  current  business  in  each  office  of  the 
Bureau  is  completed  daily  without  regard  to  hours, 
before  the  office  is  closed,  or  the  clerks  leave  for  the 
day. 

INFORMATION  FOR  PUBLIC. 

Sec.  16.  No  information  of  any  kind  is  given  to  the 
"public  except  when  authorized  by  the  Director  of  the 
Bureau.  The  names  of  complainants  are  never 
iivulged  by  anyone  connected  with  the  Department 
Df  Health.  Communications  to  co-ordinate  branches 
Df  the  city  government  are  forwarded  through  the 
Executive  Office. 

TELEPHONE  REGULATIONS. 

Sec.  17.  Departmental  telephones  are  not  to  be 
ised  for  personal  business.  Permission  to  use  the  De- 
lartment  telephones  may,  however,  be  granted  by  the 
)irector  or  his  duly  authorized  representative,  in  case 
)f  emergency.  The  date,  name  and  telephone  num- 
)er  of  person  called,  the  name  of  person  using  the 
olephone,  and  the  amount  of  the  telephone  charge, 

37 


together  with  the  money  collected,  are  to  be  for-, 
warded  monthly  to  the  Auditor  of  the  Department 
of  Health.  A  telephone  journal  (Form  4  LL)  for  all 
out-of-Borough  and  personal  caHs  and  showing  the 
above  items,  is  kept  in  every  Branch  Office,  Clinic  and 
Day  Camp,  and  also  at  the  Hospital  Admission  Bii 
reau. 

CARE  OF  DEPARTMENT  PROPERTY. 

Sec.  18.  The  property  of  the  Department  of  Health 
entrusted  to  the  care  of  employees  is  to  be  kept  in 
perfect  order.  Breakage  or  impairment  is  reported 
immediately,  in  writing,  to  the  Director  of  the  Bu- 
reau, with  an  explanation  of  the  cause. 

All  desks  are  to  be  kept  in  an  orderly  and  cleanly 
condition. 

All  ink-wells  to  be  cleaned  and  refilled  in  all  offices 
as  often  as  may  be  necessary,  and  at  least  once 
a  week. 

All  pen-holders  and  pens  are  to  be  kept  in  a  cleanly 
condition. 

All  typewriting  machines  are  to  be  kept  thoroughly 
clean,  and  in  such  condition  that  the  typewritten  mat- 
ter will  present  a  neat  appearance  and  be  plain  and 
distinct. 

Large  blue  blotters  are  to  be  provided  where  needed 
and  charged  as  soon  as  they  become  soiled  or  other- 
wise unfit  for  use. 

No  small  calendars,  advertisements,  superfluous 
cards,  or  other  unnecessary  ornaments  are  to  be  hung 
up  or  posted  on  walls  or  partitions  in  the  various 
offices. 

38 


Letter-paper  belongiug  to  the  Department  of  Health 
is  to  be  used  for  Department  of  Health  purposes 
only. 

Desks  and  tables  are  to  be  cleared  as  far  as  possi- 
ble at  the  close  of  business  each  day,  and  all  roll- 
top  desks  closed. 

All  blanks  and  stationery  are  to  be  neatly  stowed 
away  in  closets  or  cabinets  for  such  purposes,  and 
kept  in  a  proper  and  careful  manner. 

No  Avaste  paper  or  other  waste  material  is  to  be 
thrown  on  floor ;  waste  baskets  are  provided. 

Each  individual  is  held  directly  responsible  for  the 
condition  of  the  desks  and  tables  used  by  him,  and 
is  always  to  keep  the  same  in  a  neat  and  cleanly 
jondition. 

j  All  records,  reports,  correspondence  and  copies  of 
orrespon deuce  connected  with  the  work  of  the  Bu- 
•eau  of  Infectious  Diseases  are  to  be  properly  filed 
)efore  the  close  of  the  day's  work.  In  no  instance 
ire  any  such  reports,  records,  correspondence,  or 
opics  of  correspondence  to  be  put  into  the  drawers 
)r  pigeon-holes  of  desks. 

VIOLATION  OF  SANITARY  CODE. 

Sec.  19.  Any  violation  of  the  Sanitary  Code  com- 
ng  under  the  observation  of  an  employee  of  the  Bu- 
eau  is  to  be  reported  in  writing. 

SMOKING. 

Sec.  20.  Smoking  and  the  drinking  of  intoxicating 
iquors  during  ofiice  hours  are  strictly   forbidden. 

3U 


KNOWLEDGE  OF  REGULATIONS. 
Sec.    21.     Every    employee    of    the    Bureau    is    ex- 
pected  to    familiarize   himself    with    all    sections    of 
this  Handbook  which  apply  to  himself  or  his  duties. 

REGULATIONS    APPLYING    TO    ALL    OFFICERS. 


MONTHLY  CONFERENCES. 
Sec.  22.  A  conference  of  the  Chiefs  of  Division 
and  Borough  Chiefs  is  held  at  2  P.  M.  on  the  second 
Tuesday  of  each  month,  notice  of  same  being  for- 
warded (Form  279  L).  Recent  orders  and  new  pro- 
ceedings are  discussed.  A  similar  conference  of  the 
Borough  Chiefs  and  physicians-in-charge  of  Branch 
Offices  is  held  at  2  P.  M.  on  the  third  Tuesday  of  each 
month.  Similar  conferences  of  diagnosticians,  veteri- 
narians, clinic  physicians,  nurses,  etc.,  with  their  re- 
spective Chiefs,  are  held  at  regular  intervals. 

CORRESPONDENCE   AND  REPORTS. 

Sec.  23.  Complaints  (personal,  telephonic,  and 
written),  and  requests  for  information,  received  at 
the  Executive  Office,  are  entered  in  a  journal  (Execu- 
tive Office,  Form  6  LL;  Borough  and  other  Offices, 
Form  19  LL)  and  referred  to  the  proper  officer  of  the 
Bureau.  If  referred  "for  investigation  and  report,"  a 
memorandum  of  the  original  records  is  to  be  returned 
to  the  Executive  Office.  If  "for  investigation"  only 
the  matter  is  to  be  ffiially  disposed  of,  and  acknowl 
edgment  made  directly  to  the  complainant  by  the  offi 
cer,  the  papers  being  returned  for  final  reference  to  th( 
Central  Filing  Bureau. 

Similar  communications  made  directly  to  an  office] 
of  the  Bureau  are  to  be  investigated,  and  disposed  o: 

40 


by  him,  or  if  bis  judgment  so  dictates  referred  to  the 
Director.  All  matters  dealing  with  the  policy  of  the 
Department  of  Health  are  to  be  referred  to  the  Ex- 
ecutive Office. 

Carbon  copies  of  all  correspondence,  reports,  etc., 
are  tiled  according  to  subjects  and  cross  referenced 
by  means  of  a  card  index  of  names  and  addresses. 
Every  report,  complaint,  etc.,  of  which  there  is  no 
carbon  copy,  is  journalized  before  being  forwarded. 

All  papers  received  at,  or  forwarded  from  the 
Executive  Office,  are  journalized  there  (Form  6  LL). 

CENTRAL  FILING  BUREAU. 

Sec.  24.  The  central  filing  bureau  for  all  com- 
pleted correspondence,  discarded  records,  etc.,  is  lo- 
cated in  the  office  of  the  Secretary  of  the  Department 
of  Health,  at  Centre  and  Walker  Streets.  All  com- 
pleted correspondence  is  to  be  forwarded  to  the  Exec- 
utive office,  securely  wrapped  in  packages  of  conve- 
nient size,  marked  "For  Central  Filing  Bureau."  Each 
package  should  be  clearly  labeled  with  a  description 
of  its  contents,  and  the  name  of  the  office  from  which 
it  comes.  All  cards,  records,  etc.,  that  are  no  longer 
in  use  should  be  forwarded  in  the  same  way.  Climes 
and  Borough  Offices  should  forward  histories  of  dead 
cases  of  tuberculosis  dating  back  two  years,  and  old 
typhoid  and  other  histories ;  the  Diagnosis  Laboratory 
and  Borough  Offices,  all  specimen  slips  no  longer  in 
active  use ;  the  Branch  Offices,  all  old  daily  reports 
to  and  from  the  Borough  Offices,  and  all  "discontinued 
cases"  more  than  two  years  old. 

These  records  can  be  consulted  at  any  time,  or 
obtained  on  request. 

41 


GENERAL  DUTIES. 

Sec.  25.  Officers  must  properly  indorse  and  for- 
ward to  tlie  Executive  Office  all  bills,  requisitions, 
reports,  applications  for  leave  of  abs'ence,  carfare  and 
telephone  bills,  and  immediately  upon  receipt  of  all 
goods  must  sign  and  forward  receipt  for  same  (Form 
228  L).  Tbey  must  forward  a  vacation  schedule  for 
employees  under  their  supervision,  to  the  Executive 
Office  by  May  1st  of  each  year. 

They  must  keep  a  diary  of  the  daily  events,  de- 
linquencies, etc.,  occurring  in  their  offices  or  among 
those  under  them,  and  in  making  reports  to  the 
Director,  specific  facts,  dates,  etc.,  must  be  given. 
The  diaries  are  inspected  at  the  close  of  each  yenr. 
All  delinquencies  of  subordinates  are  also  recorded  in 
a  card  index. 

All  complaints  received  are  to  be  forwarded  to 
the  comijlaint  clerk  of  the  Borough,  who  will  enter 
them  in  his  journal  and  return  them  for  investiga- 
tion. All  reports  are  made  on  the  Bureau  letter-head 
(Form  131  L). 

SPECIAL  DUTIES. 

Sec.  26.  (a)  Director.  The  Director  has  full  au- 
thority over  all  branches  of  the  work  of  the  Bureau. 
He  informs  the  Commissioner  from  time  to  time  as 
to  the  character  and  amount  of  work  performed  by 
the  Bureau  and  forwards  such  written  reports  as  may 
be  required.  He  supervises  the  work  of  the  Bureau, 
directs  the  detailing  of  all  employees,  and  makes  such 
changes  in  the  methods  employed  as  will  best  carry 
out  the  work  of  the  Bureau. 

42 


In  the  absence  of  the  Director,  the  Medical  In- 
spector, detailed  as  Assistant  to  the  Director,  is  in 
charge  of  the  work  of  the  Bureau. 

A  special  assignment  slip  is  used  in  this  office  (Form 
19  L). 

(b)  Chiefs  of  Division.  The  Chiefs  of  Division 
exercise  general  supervision  over  all  matters  pertain- 
ing to  the  work  of  their  particular  divisions  through- 
out the  city. 

(c)  BoEOUGH  Chief:  Each  Borough  Chief  is  re- 
spousible  for  the  notification,  registration,  sanitary  su- 
pervision, disinfection  and  removal  to  hospital  (when 
necessary)  of  all  cases  of  infectious  diseases,  includ- 
ing tuberculosis,  occurring  in  his  borough.  He  is  also 
responsible  for  the  registration  of  glanders  and  dog 
bites.    He  submits  and  records  the  following  reports : 

Daily  telephone  report  to  the  Executive  Office  be- 
fore 9.15  A.  M.  each  day,  of  the  work  of  the  Bureau, 
absences,  etc.,  in  the  Borough  for  the  preceding  twen- 
ty-four hours ;  the  number  of  new  cases  of  tuber- 
culosis. 

Weekly  summary  of  new  cases  of  tuberculosis  for 
preceding  week,  by  telephone,  to  Executive  Office 
every  Monday  morning. 

Weekly  report  to  the  Executive  Offi-ce  (Form  230  L) 
to  be  used  in  compiling  the  weekly  report  of  the 
Bureau  to  the  Conuuissioner.  In  a  loose  leaf  record 
(25.0  L)  is  recorded  the  weekly  summary  of  the  daily 
reports  of  each  inspector,  so  that  his  work  for  the  year 
can  be  seen  at  a  glance. 

Monllily  summary  to  the  Executive  Office  of  total 
number  of  hours  on  duty  of  each  inspector. 

43 


Inventory  of  stock  of  blanks  on  the  fifteenth  day  ol 
January,  May  and  September,  and  report  of  same  tc 
the  Executive  Office   (Form  53  L). 

Annual  and  semi-annual  reports  to  the  Director  of 
Bureau,  of  work  performed  in  the  Borough. 

Daily  record  of  number  of  new  cases  of  tubercu- 
losis and  how  reported,  number  of  cases  among  chil- 
dren, and  other  data. 

There  is  kept  on  a  bulletin  board   (a)   the  list  of 
supply  stations  in  the  Borough;  (b)  a  list  of  Sunday,! 
holiday  and  night  assignments  of  inspectors ;  and  (e) 
all  current  orders,  notices,  etc. 

All  reports  of  cases  of  tuberculosis  from  private 
physicians,  whether  by  postal  or  positive  laboratory 
specimens,  are  acknowledged  by  letter  (Form  IG  L). 

(d)  Physicians-in-Chakge.  Each  Physician-in- 
charge  is  responsible  for  the  registration  and  sani- 
tary supervision  of  all  infectious  diseases  in  his  dis- 
trict unit,  the  conduct  of  his  clinic  and  for  the  work 
of  all  employees  attached  to  his  office.  He  is  the 
head  of  the  district  organization  and  is  responsible 
for  the  accuracy  of  all  reports  and  files  as  well  aa 
the  prompt  disposition  of  cases  assigned. 

REGULATIONS    APPLYING    TO    FIELD 
WORKERS. 

DAILY   REPORTS. 

Sec.  27.  All  field  workers  (district  diagnosticians, 
inspectors,  district  nurses,  veterinarians,  disinfectors, 
etc.)  submit  a  daily  report  of  work  performed  (In- 
spectors, Form  108  L;  Nurses,  Form  259  L;  Veteri- 
narians, Form  16.5  J;  Disinfectors,  Form  169  J),  in- 

44 


eluding  hour  of  arrival  at  each  assignment,  and  total 
number  of  hours  on  duty.  These  reports  are  made 
out  at  the  office  of  the  district  to  which  these  em- 
ployees are  detailed,  forwarded  to  the  Borough  Office 
each  day  in  addressed  envelopes  (Forms  91,  100  and 
114  L)  and  there  kept  on  file.  At  stated  intervals 
the  correctness  of  these  reports  is  investigated  by 
another  inspector  or  nurse,  who  repeats  each  visit 
paid  the  day  before,  and  submits  a  report  (Form 
4  L). 
I  SEARCH  FOR  NEW  CASES. 

I  Sec.  28.  Every  Diagnostician,  Medical  Inspector, 
'Clinic  Physician  or  Nurse,  when  entering  for  the  first 
time  any  building  used  for  residential  purposes,  in- 
quires of  the  janitor  or  person  in  charge  as  to  the  ex- 
istence of  any  cases  of  illness  on  the  premises.  If 
'informed  that  any  such  cases  exist,  they  are  at  once 
inquired  into.  This  is  understood  as  included  in  all 
^instructions  regarding  assignment  of  district  work. 
The  above  employees  carry  postal  cards  for  reporting 
ases  of  infectious  diseases. 

BADGES. 

Sec.  29.  Each  physician  and  nurse  must  wear  the 
Department  badge  while  on  duty.  It  must  not  be 
carried  in  their  pockets,  bags  or  card  cases. 

PERSONAL    ATTENTION   TO    ASSIGNMENTS. 

Sec.  30.  Unless  otherwise  specifically  stated,  all 
issignments  require  that  the  inspector  or  nurse  visit 
premises  in  person.  Information  obtained  by  tele- 
ohone  is  not  to  be  submitted  as  a  report  of  an  iuspec- 
:ioD. 

45 


CARFARE  AND  TELEPHONE  BILLS. 

Sec.  31.  Certain  employees  of  the  Bureau  whc 
spend  money  for  carfare  and  for  telepbone  servict 
while  engaged  in  tlie  performance  of  their  official 
duties,  are  reimbursed  by  the  Department  of  Health 
Each  5-cent  item  spent  for  carfare  is  accounted  foi 
by  giving  points  to  and  from  which  the  car  wa^ 
taken.  The  first  and  last  fare  of  the  day  must  no1 
be  charged,  nor  is  carfare  allowed  between  the  em 
ployee's  house  and  the  Borough  Office.  Intersecting 
points  and  not  house  numbers  must  be  given.  Eact 
5-cent  item  spent  for  telephone  service  is  accountec 
for  by  giving  the  number  of  the  stations  to  and  fron 
which  the  call  was  made.  Unintelligible  abbrevia 
tions  must  not  be  used.  At  the  end  of  each  montt 
the  employees  sign  and  swear  to  their  monthly  bilh 
at  the  respective  Borough  Offices. 

The  carfare  and  telephone  bills  (Forms  243  anc 
244  L)  are  made  out  in  duplicate,  signed  and  swori 
to  by  the  employee,  certified  by  his  or  her  superio], 
officer,  and  forwarded  to  the  Director  by  the  fifth  da3 
of  each  month.  A  record  is  kept  of  the  amount,  dat( 
of  receipt  and  date  of  forwarding  of  each  employee's 
bill. 

All  bills  are  then  certified  to  by  the  Director  anc 
forwarded  to  the  Auditor  of  the  Department  ol 
Health.  When  the  bills  are  paid,  the  checks  are  sen! 
to  the  Chiefs  of  Divisions,  who  distribute  the  money 
obtain  receipts  from  the  employees  and  returr 
them  to  the  Executive  Office. 

Collectors  are  paid  their  carfare  in  advance,  fron 
two  special  funds  of  $500  each,  provided  for  that  pur 
pose,   giving   receipts    (Form   94  L)    for  amount  re 

46 


ceived.  Their  bills  must  be  approved  by  the  Assistant 
Director  of  the  Diagnosis  Laboratory.  At  the  end  of 
each  month  they  submit  sworn  vouchers,  showing 
how  money  was  used.  These  vouchers  are  submitted 
to  the  Department  of  Finance  in  lots  of  $500. 

ROUTINE    PROCEDURE— EXECUTIVE    OFFICE. 
DUTIES  OF  CHIEF  CLERK. 
Sec.  32.    The  Chief  Clerk  of  the  Bureau  is  respon- 
sible  for    the   proper   performance    of    the    following 
routine  duties : 

REPORTS. 

Sec.  3.3.  A  daily  report  to  the  Commissioner  giving 
the  number  of  cases  of  infectious  diseases  reported 
during  the  preceding  twenty-four  hours  as  compared 
with  the  corresponding  date  of  the  previous  year 
(Form  185  L).  Copies  are  also  mailed  in  envelopes 
(Form  6  J)  to  the  Health  Officer  of  the  Port,  Acad- 
emy of  Medicine  (Form  3  J),  and  to  the  State  Board 
of  Health   (Form  8  J). 

A  weekly  report  every  Wednesday  to  the  Commis- 
sioner of  the  work  of  the  Bureau  (Form  13  L),  com- 
piled from  the  weekly  reports  of  the  Chiefs  of  Di- 
vision and  Borough  Chiefs,  Superintendent  of  Nurses, 
Hospital  Admission  Bureau,  and  the  Assistant  Direc- 
tor of  the  Diagnosis  Laboratory.  The  complete  re- 
port for  each  week  is  copied  in  a  loose-leaf  record 
(Form  255  L). 

Similar  quarterly,  semi-annual  and  yearly  reports 
are  submitted  giving  the  figures  compiled  from  the 
weekly  reports  during  those  respective  periods. 

A  monthly  pay-roll  is  forwarded  on  the  ]5th  of 
each  month,  giving  the  name,  title,  and  current  salary 
of  every  employee  on  active  duty  in  the  Bureau. 

47 


OFFICE  OF  SUPPLIES. 

Sec.  34.  All  matters  concerning  supplies,  blanks 
repairs  and  alterations,  and  bills  for  the  same,  an 
cared  for  by  the  Orliee  of  Supplies. 

Borough  and  Division  requisitions .  (Form  59  L] 
for  all  requirements  are  referred  to  this  office. 

Department  requisitions  (Form  08  B)  are  thei 
made  out,  and  after  approval  and  signature  oi 
Director,  are  forwarded  to  the  Commissioner  for  his 
approval.  If  approved,  a  notice  to  that  effect  is  re 
ceived  from  the  Chief  Clerk  of  the  Department  ol 
Health. 

All  requisitions,  orders  and  bills  are  filed  in  large 
manila  envelopes  (Form  118  L). 

When  goods  have  been  delivered  and  accepted,  a 
receipt  (P'orin  228  L)  is  to  be  forwarded  immediatelj 
to  the  Executive  Otfice. 

Consignors  are  required  to  submit  their  bills  in 
quadruplicate,  accompanied  by  the  original  order.  A 
"received"  stamp  is  placed  on  the  back  of  three  bills, 
and  they  are  signed  by  the  employee  accepting  the 
goods.  Certification  slips  (Form  197  L)  are  attached 
to  two  copies,  signed  and  forwarded  to  the  Auditor  of 
the  Department  of  Health.  Employees  receipting  bills 
are  held  responsible  for  the  proper  fulfillment  of  the 
order.  The  quadruplicate  copy  of  the  invoice,  to- 
gether with  a  statement  (Form  4  C)  showing  name  of 
vendor,  articles  received,  and  l)y  whom  received,  is 
forwarded  to  the  Auditor  and  by  him  to  the  Division 
of  Inspections,   Department  of   Finance. 

A  requisition  is  forwarded  on  the  first  of  each 
month    for    the    regular    current    expenses    of    the 

48 


Bureau — ice,  express  charges,  drugs,  carfares,  tele- 
phone calls,  food  for  camps,  repairs  to  instruments, 
blood  for  the  preparation  of  culture  media,  carfare 
expenses  of  employees,  etc. 

RECORDS,  BLANKS,  ETC. 

Sec.  35.  Each  of  the  blanks,  circulars,  leaflets,  en- 
velopes, record  books,  etc.,  has  a  form  number  by 
which  it  is  known,  the  letter  "L"  or  "J"  placed  after 
each  number  indicating  the  Bureau  of  Infectious 
Diseases.  Two  "L's"  or  two  "J's"  indicate  a  bound 
record.  A  complete  record  is  kept  of  each  blank  on 
the  outside  of  large  manila  envelopes  (Form  115  L) 
filed  serially,  showing  the  date  and  amount  of  all 
special  and  annual  requisitions,  date  of  proof,  receipt, 
and  the  date  the  printed  matter  was  received.  The 
stock  on  hand  at  the  end  of  every  four  months  is  also 
shown.  The  envelopes  contain  three  of  the  latest 
samples  of  each  form.  A  card  index,  arranged  ac- 
cording to  subjects  and  titles,  is  also  used  as  a  cross 
reference. 

The  annual  requisition  for  blanks,  stationery,  etc., 
is  forwarded  to  the  Chief  Clerk  of  the  Department 
of  Health  on  the  first  of  July  of  the  preceding  year. 
The  form  number,  description,  estimated  amount  used 
monthly,  and  the  number  needed  for  each  Borough 
are  stated.  A  sample  of  each  form  ordered  must  be 
forwarded  with   the   requisition. 

Supplies  of  blanks,  etc.,  are  forwarded  to  Borough 
Offices  in  special  envelopes  (Form  253  L). 

EFFICIBx>JCY  RATINGS. 
Sec.   36.     On   November   10th,    1913,    with    the    ap- 
proval of  the  Commissioner,  the  Director  appointed  a 

49 


Committee  on  Grading  and  Efficiency  to  consist  of 
five  members.  The  Medical  Inspectors,  Clinic  Phy- 
sicians, Nurses,  Laboratory  workers,  and  the  Clerical 
Staff  of  the  Bureau,  are  represented  on  this  Com- 
mittee. 

This  Committee  supervises  the  efficiency  ratings 
of  the  employees  of  the  Bureau,  subject  always  to 
Civil  Service  requirements. 

Each  employee  is  rated  by  the  superior  officer  in 
closest  touch  with  his  work.  Ratings  received  by 
superiors,  if  approved,  are  forwarded  without  change; 
if  not  approved,  they  are  forwarded  with  necessary 
comments  and  explanations.  A  permanent  record  of 
quarterly  ratings  is  kept  in  each  Borough  and  Division 
Office  (Form  28B). 

At  the  end  of  each  quarter,  each  rating  official  for- 
wards to  the  Committee  a  list  containing  name,  Civil 
Service  title,  date  of  appointment  and  rating  of  each 
euiployee  rated  by  him.  If  the  rating  is  above  or 
below  "average"  an  explanation  must  accompany  it 
on  card  (Form  93  L). 

All  delinquencies  are  noted  on  the  quarterly  rating 
card. 

Employees  are  rated  according  to  following 
schedule : 

1.  Quality   of  work 30 

(a)  Results   obtained  20 

(b)  Promptness    5 

(c)  Care   of  property 5 

2.  Quantity   of    work 20 

60 


General  conduct   20 

(a)  Willingness    5 

(b)  Courtesy    5 

(c)  Neatness   5 

(d)  Personality    5 

Executive  ability  and  capacity  for  initiative. . .  20 

(a)  Executive  ability   10 

(b)  Capacity  for  initiative 10 

Attendance    10 

INFECTIOUS  DISEASES. 

GENERAL  PROCEDURE. 

BOROUGH  OFFICES. 
Sec.  37.  A  Borough  Office  of  the  Bureau  is  located 
n  each  of  the  five  Boroughs  of  the  City.  (See 
Directory  Sec.  2.)  Each  Borough  Office  is  under  the 
'lirection  of  a  Borough  Chief  and  has  a  staff  consist- 
ing of  a  Borough  Diagnostician,  Chief  Clerk,  Disin- 
I'ector-in-charge,  clerks  and  stenographers.  At  these 
)ffices  are  registered  and  eventually  filed  all  cases  of 
nfectious  diseases  occurring  in  the  Borough. 

NOTIFICATION  OF  INFECTIOUS  DISEASES. 

Sec.  38.  The  Department  of  Health  is  notified  by 
aw  of  all  cases  of  infectious  disease  occurring  in  the 
Dity  of  New  York.    These  cases  are  reported  by — 

a.  Private  physicians — 

(1)  in  writing. 

(2)  by  laboratory  specimen. 

[Note. — Delinquent  List.  The  names  of  those  phy- 
sicians who  fail  to  promptly  report  the  cases  of  infec- 
:ious  diseases  (Sanitary  Code  Sec.  4  A)   under  their 

51 


professional  care,  are  forwarded  to  the  Executive  Of 
fice  on  a  special  card  (Form  —  L).  Upon  the  occur 
rence  of  a  second  offence,  legal  proceedings  may  be 
instituted.] 

b.  Institutions. 

When  a  case  of  infectious  disease  occurs  in  an  in 
stitutiou  the  Department  of  Health  is  at  once  notified 
by  telephone. 

Note. —  (Cases  of  tuberculosis  are  reported  by  tele 
phone  to  the  Hospital  Admission  Bureau,  which  in 
turn  reports  the  cases  to  the  Borough  Offices  of  the 
Department  of  Health.) 

The  Tuberculosis  Clinics  (Department  and  Non 
Department)  report  daily  to  the  local  Branch  Office 
and  thence  in  turn  to  the  local  Borough  Office  (Form 
94  L).  [To  facilitate  the  collection  of  this  informa- 
tion and  obviate  delay,  confusion  and  error,  special 
record  books  are  furnished  to  each  Non-Department 
Clinic  (Form  9  LL.)] 

Tuberculosis  sanatoria  report  their  cases  by  mail 
on  blanks  furnished  for  that  purpose  (209  L),  to  the 
Hospital  Admission  Bureau,  which  in  turn  reports 
to  the  Branch  Offices  of  the  Department  of  Health. 

c.  Deaths  from  infectious  diseases  are  reported  by 
the  death  certificates  forwarded  by  the  attending 
physician  to  the  Bureau  of  Records  of  the  Depart 
ment  of  Health,  and  thence  to  the  Borough  Office  of 
the  Bureau  of  Infectious  Diseases. 

d.  Complaints  from  lay  individuals  or  organiza- 
tions, and  by  employees  of  the  Department  of  Health 
and  other  branches  of  the  City  Government.  Inspec- 
tors (Form  4.3  J),  Sanitary  policemen  (Form  39  J). 
Policemen  report  on  Form  175  J. 

52 


e.  Nurses  and  visitors  of  charitable  organizations 
■eport  cases  coming  under  observation  on  a  special 
'ard  (Form  277  L).  Every  case  of  infectious  disease 
•eported  is  acknowledged. 

REGISTRATION  OF  INFECTIOUS  DISEASES. 

Sec.  39.  All  cases  reported  are  registered  at  the 
Department  of  Health  and  all  necessary  steps  are 
aken  to  render  both  notification  and  registration  as 
Lccurate  and  complete  as  possible. 

The  system  of  registration  for  all  infectious  dis- 
eases is  essentially  uniform.  In  tuberculosis,  because 
►f  the  prolonged  period  of  supervision  for  each  case, 
he  system  has  been  considerably  elaborated. 

This  system  of  registration  and  sanitary  super- 
'ision,  depending  as  it  does  upon  the  subdivision  of 
;ach  Borough  into  co-ordinate  parts,  and  locating 
herein  the  records  of  the  infectious  diseases  of  that 
)art  has  greatly  increased  the  accuracy,  flexibility 
md  ethciency  of  the  work.  A  great  amount  of  dupli- 
;ate  reporting  and  copying  has  been  done  away  with, 
md  a  more  complete  control  of  the  nurses  both  as  to 
he  quality  and  quantity  of  work  done  has  been  at- 
ained. 

RECORDS  AT  BOROUGH  OFFICES. 

Sec.  40.  All  cases  of  infectious  diseases  reported 
0  the  Department  of  Health  are  registered  at  the 
)ffice  of  the  Borough  in  which  they  occur.  The  in- 
ormation  thus  received  is  forwarded  to  the  proper 
Branch  Office,  by  telephone  and  daily  written  report. 

The  results  of  examination  of  diphtheria  cultures, 
idmissions    to    and    discharges    from    hospitals,  and 

53 


deaths,  are  reported  to  the  Branch  Office  daily  on  i 
special  blank  (Form  23  J  and  89  L). 

A  daily  report  (Form  IJ)  of  new  and  discontinue( 
cases  of  infectious  diseases,  with  corresponding  fig 
ures  for  the  preceding  year,  is  forwarded  to  the  Ex 
ecutive  Office. 

A  list  of  all  new  and  discontinued  cases  of  infec 
tious  diseases  is  sent  daily  to  the  printer.  The  printet 
lists  are  mailed  by  the  printer  in  envelopes  furnishe( 
by  the  Board  of  Education  to  public  schools,  and  t( 
others,  iu  envelopes  furnished  by  the  Department  o: 
Health  (Form  80  J). 

The  following  records  of  cases  of  infectious  diSi 
eases  are  maintained: 

(a)  General  Envelope  Name  File  of  current  cases 
of  diphtheria,  measles,  scarlet  fever,  typhoid  fever 
cerebro-spinal  meningitis,  acute  poliomyelitis  anc 
smallpox.  When  an  envelope  is  temporarily  removed 
a  tally  card  (Form  13G  J)  is  substituted  therefor. 

(b)  House  File. — Every  case  of  the  more  import 
ant  infectious  diseases,  with  the  exception  of  tuber 
culosis,  is  entered  by  name  on  a  house  card  (Form 
9.5  L),  which  is  filed  in  the  Borough  Office.  [The 
tuberculosis  house  cards  are  filed  in  the  Branch 
Offices.]  All  subsequent  cases  reported  from  that  ad- 
dress are  recorded  on  the  same  card.  If  not  found  at 
the  address  given,  that  fact  is  noted  later  in  column 
"Location  of  Apartment."  [In  private  physicians' 
cases  of  tuberculosis,  the  physician's  report  is  ac- 
cepted and  the  case  entered  on  the  house  card,  the 
address  being  verified  by  the  district  nurse.  In  cases 
reported  by  non-Department  clinics,  the  nurses  of  that 
clinic  district  obtain  the  desired  information  regarding 

54 


the  house  and  forward  it  on  a  special  card  (Form 
149  L).]  On  the  house  card  are  entered:  (1)  The 
street  and  number,  the  Borough,  the  number  of  stories 
in  the  house,  the  material  of  whicli  it  is  built,  if  built 
before  or  after  1901  (the  year  the  new  tenement  law 
went  into  effect)  ;  its  condition,  and  its  character  (ten- 
ement, private  house,  hotel,  etc.),  and  the  number  of 
cases  of  tuberculosis  reported  from  the  house  prior  to 
1910  (the  year  the  house  file  was  begun).  All  this 
constitutes  a  permanent  record  of  the  house  itself;  (2) 
the  name  of  every  patient  reported  from  that  house 
since  January  1,  1910,  the  date  case  was  reported, 
record  number,  location  and  number  of  rooms,  how 
long  patient  had  been  in  house,  date  patient's  family 
left  house,  what  disinfection  was  performed,  and  of 
what  rooms,  where  family  moved  to,  and  date  of 
death  or  recovery  of  patient.  [All  living  cases  of  tu- 
berculosis In  the  register  on  January  1,  1910,  were 
9ntered  in  this  file.]  These  cards  are  filed  accord- 
ing to  address  and  take  the  place  of  the  house  maps 
tvhich  (in  Manhattan)  had  been  maintained  for  the 
irevious  fifteen  years.  Not  only  are  the  records  of 
;reat  value  in  furnishing  evidence  that  a  given  house 
(or  rooms  in  that  house)  is  dangerous  to  live  in,  but 
hey  also  serve  to  identify  patients.  Many  foreigners 
ire  reported  under  different  names  from  different 
'.ources,  and  can  only  be  identified  by  such  an  index 
is  this.  When  it  is  ascertained  that  a  house  has  been 
orn  down,  this  fact  is  entered  on  card  and  a  new  card 
tarted  when  a  new  case  is  reported  from  the  new 
lOuse. 

(c)  Laboratory  file  of  active  cases  of  diphtheria. 

(d)  Laboratory  file  of  active  cases  of  typhoid  fever. 

55 


(e)  Card  name  file  (126  L)  of  active  cases  of  pul 

monary  tuberculosis. 

(f)  Separate  discontinued  envelope  name  files  oi 
terminated  cases  of, — 

(1)  diphtheria 

(2)  scarlet  fever 

(3)  measles 

(4)  typhoid  fever 

(5)  cerebro-spinal  meniugitis 

(6)  acute  poliomyelitis 

(7)  smallpox 
(S)  glanders 

(0)  dog  bite 

(g)  Separate  report  postal  address  files  of, — 

(1)  German  measles 

(2)  mumps 

(3)  chicken  pox 

(4)  whooping  cough 

(h)  Borough  envelope  name  "not  found"  file  of  cases 
of  pulmonary  tuberculosis.  (The  general  "homeless' 
file  of  cases  of  pulmonary  tuberculosis  for  the  greatei 
City  is  Isept  in  the  Executive  OfQce.) 

(i)  Envelope  name  file  of  dead  eases  of  pulmonarj 
tuberculosis. 

BRANCH  OFFICES. 

Sec,  41.  Each  Borough  is  divided  into  one  or  more 
district  units,  within  each  of  which  is  located  a  Branch 
Office  of  the  Bureau.  (For  diagram  and  boundaries  of 
the  districts  see  Directory,  Sec.  2.)  Each  Branch  Of 
fice  is  under  the  supervision  of  a  Physician-in-charge 
and  has  a  staff  consisting  of  a  District  Diagnostician, 
Supervising  Nurse,  and  corps  of  district  nurses,  clinic 

56 


; physicians,  cleaners,  etc.  All  matters  pertaining  to  in- 
fectious diseases  occurring  in  the  district  are  referred 
to  the  Physician-in-charge.  At  these  offices  are  filed 
the  records  of  all  active  cases  of  infectious  diseases, 
except  typhoid  fever,  occurring  in  the  unit.  Upon 
termination  of  each  case,  its  records  are  forwarded  to 
the  Borough  Office. 

I  BRANCH  OFFICE  SYSTEM  OF  REGISTRATION. 

Sec.  42.  The  new  Branch  Office  system  of  registra- 
tion was  introduced  late  in  1911,  and  has  proven  en- 
tirely satisfactory.  It  is  a  return  to  the  old  system  in 
vogue  prior  to  1910.  In  brief  it  consists  in  locating  the 
Irecorda  in  the  clinic  districts,  so  that  they  may  be 
'readily  accessible  to  and  corrected  by  the  district 
nurses.  The  records  are  given  out  to  the  diagnos- 
ticians and  nurses,  who  make  their  reports  on  them. 
This  does  away  with  a  great  amount  of  duplicate 
reporting  and  copying.  Lastly  the  work  of  the  diag- 
jnosticians  and  nurses  is  under  complete  control.  Their 
Iday'g  work  can  be  laid  out  the  day  before,  and  is  ready 
for  them  eacb  morning.  An  exact  day's  work,  appor- 
tioned to  the  size  of  the  district,  can  be  assigned. 
Every  assignment  is  reported  on  the  next  working 
morning. 

RECORDS  AT  BRANCH  OFFICES. 

Sec.  43.  At  each  Branch  Office  are  located  the 
records  of  all  active  cases  of  infectious  diseases  occur- 
ring in  the  district  unit.  The  district  nurses  make 
their  reports  on  the  official  records  of  the  cases. 

All  new  cases  of  infectious  diseases  are  entered  in  a 
djjjly  telephone  Journal  (Form  SLL),  as  they  are 
received  from  the  Borough  Office. 

57 


The  following  records  of  cases  of  infectious  diseases 
are  maintained  at  each  Branch  Office : 

(a)  General  name-file  for  each  nurse's  district,  of 
histories  of  active  cases  of  diphtheria,  scarlet  fever, 
measles,  typhoid  fever,  cerebro -spinal  meningitis  and 
acute  poliomyelitis ; 

(b)  General  date  tally  file  according  to  nurses'  dis- 
tricts, of  above  diseases. 

(c)  Envelope  name-file,  according  to  nurses'  districts, 
of  active  cases  of  pulmonary  tuberculosis. 

(d)  House  file,  according  to  nurses'  districts,  of 
cases  of  pulmonary  tuberculosis   (see  Sec.  40  b.) 

(e)  Date    tally    file    (Form    12G    L)    according    to 
nurses'  districts,  of  active  cases  of  pulmonary  tuber 
eulosis. 

(f )  Envelope  name  file,  according  to  clinic  districts, 
of  temporarily  discontinued  cases  of  pulmonary  tuber- 
culosis. 

GENERAL  PROCEDURE  AT  BRANCH  OFFICES. 
Sec.  44.  On  receipt  of  report  of  a  case  from  what- 
ever source,  it  is  entered  in  the  Borough  Office  Jour- 
nal (Form  3LL),  searched  for  in  the  files  and  if 
found  to  have  been  previously  reported,  any  new  facts 
received  are  entered  on  the  records.  If  a  new  case, 
it  is  at  once  assigned  to  the  nurse  in  whose  subdistrict 
it  is  located.  On  the  arrival  at  the  home  the  nurse 
obtains  a  complete  history  of  the  case  and  takes  such 
further  action  as  the  exigency  and  character  of  the 
case  demand.  The  routine  procedure  followed  by  an 
inspector  or  nurse  of  the  Department  in  attendance 
upon  any  case  of  infectious  disease  is  described  in 
detail  under  each  disease.    All  persons  (or  families  oi 

58 


uch  persons)  suffering  from  these  diseases  are  in- 
tructed  as  to  the  proper  measure  to  be  taken  to  pre- 
'ent  tlieir  spread. 

According  to  the  results  of  the  investigation,  cases 
tre  classed  as  "supervision"  cases  (visited  every  few 
lays)  if  they  need  close  watching,  or  as  "observation" 
ases  (visited  at  relatively  long  Intervals)  if  kept 
mder  observation  only.  Every  case  occurring  among 
school  children  or  teachers  is  reported  to  the  Bureau 
>f  Child  Hygiene  through  the  Borough  Office  (Form 
151J). 

TALLY  OR  "TICKLER"  FILES. 

Sec.  4.5.  In  each  Branch  Office  tally  files  are  kept, 
)y  means  of  which  are  assigned  to  the  nurses  the 
primary  and  later  history  cards  of  all  cases  of  infec- 
tious disease  under  observation  or  supervision,  which 
ire  to  be  revisited.  On  the  tally  card  (Form  126  L) 
ire  entered  the  name  and  address  of  the  patient,  and 
iate  report  is  due. 

Tally  cards  of  all  new  cases  received  and  assigned 
are  compared  with  the  daily  printed  list  on  the  fol- 
lowing morning  to  make  certain  that  every  case  has 
been  received  and  assigned. 

TALLY  SHEETS  AND  WEEKLY  REPORT. 

Sec.  46.  Large  daily  tally  sheets  (Form  36  L  for 
tuberculosis.  Form  42  J  for  other  infectious  diseases) 
are  kept  posted  in  each  Branch  Office.  On  these  are 
'  entered  the  number  of  additions  to  and  removals  from 
tlu'  active  files,  the  results  being  totaled  daily.  On  these 
slicets  are  also  recorded  the  number  of  new  cases, 
duplicates  and  deaths  reported;  the  removals  calling 
for  disinfection,  and  the  disinfections  and  renovations 

59 


ordered,  and  other  items  for  the  weekly  report  of  the 
Branch  Office   (Form  35  L). 

DAILY  REPORT  TO  BOROUGH  OFFICE. 
Sec.  47.  Each  Branch  Office  forwards  a  daily  re- 
port to  the  Borough  Office  by  collector  (Form  94  L). 
It  is  begun  in  the  clinic  the  day  before,  and  gives  all 
information  obtained  from  the  tuberculosis  clinics  and 
district  nurses  as  to  new  cases,  change  of  address  or 
of  class,  deaths  out  of  city,  duplicates, — in  short,  all 
information  required  by  the  Borough  Office  to  correct 
the  central  name  files.  These  reports  are  returned 
from  the  Borough  Office  the  following  day,  and  are 
filed  in  a  loose-leaf  binder  together  with  the  corres- 
ponding daily  report  from  the  Borough  Office  (89  L). 
The  two  thus  constitute  a  daily  journal.  (The  daily 
reports  from  the  Borough  Office  are  submitted  to  the 
clinic  for  correction  of  its  records  before  being  filed.) 

DIVISION  OF  CONTAGIOUS  DISEASES. 

Sec.  48.  The  Division  of  Contagious  Diseases  is  re 
sponsible  for  the  notification,  registration,  sanitary 
supervision,  diagnosis,  isolation,  removal  to  hospital, 
and  disinfection  in  all  cases  of  infectious  diseases 
(except  tuberculosis,  typhoid  fever  and  venereal  dis- 
eases) occurring  in  New  York  City. 

The  registration,  sanitary  supervision  and  care  of 
small-pox,  cholera,  plague,  yellow  fever,  typhus  fever, 
diphtheria,  measles,  scarlet  fever,  chicken-pox,  German 
measles,  mumps,  whooping  cough,  cerebro-spinal  men- 
ingitis, acute  poliomyelitis,  tetanus,  anthrax,  glanders 
(human),  leprosy,  trichinosis,  malarial  fever  and  ery- 
sipelas by  the  Division  of  Contagious  Diseases  are 
organized  as  follows: 

60 


CHIEF  OF  DIVISION. 

Sec.  49.  The  Cbief  of  Division  exercises  general 
supervision  over  all  matters  pertaining  to  the  work  of 
the  Division  throughout  the  City. 

The  Chief  Diagnostician,  and  the  Physician-in-charge 
Df  Ambulances,  Disinfecting  Stations  and  Stables  re- 
port to  him. 


DUTIES  OF  CHIEF  DIAGNOSTICIAN. 

Sec.  50.  The  Chief  Diagnostician  sees  all  cases  of 
actual  and  suspected  small-pox,  typhus  fever,  yellow 
fever,  cholera,  plague  and  human  glanders,  also  all 
doubtful  cases  of  adult  chicken-pox  and  all  doubtful 
and  disputed  cases  of  other  infectious  diseases.  He 
holds  monthly  conferences  with  Borough  and  District 
Diagnosticians  and  holds  clinics  in  Department  hos- 
pitals on  all  suitable  cases  of  special  interest.  He 
keeps  a  record  of  the  correctness  of  the  diagnoses  of 
District  Diagnosticians  and  of  Institution  Inspectors 
in  connection  with  cases  removed  to  Department  hos- 
pitals, reporting  all  errors  discovered  to  the  diagnos- 
tician at  fault. 


DUTIES    OF    BOROUGH    DIAGNOSTICIAN. 

Sec.  51.  Borough  Diagnosticians  relieve  the  Bor- 
ough Chief  and  inspect  adult  cases  of  chickenpox  and 
8uch  other  cases  as,  in  the  absence  of  the  proper 
district  diagnostician,  may  be  referred  to  them  by  the 
Borough  Offices  or  by  the  Chief  Diagnostician. 

CI 


DUTIES  OF  DISTRICT  DIAGNOSTICIAN 

Sec.  52. 

A.     (1)  The  District  Diagnostician  is  on  duty  at  al 
hours. 

(2)  Each  morning    (except   Sundays  and  holi- 

days) he  reports  in  person  at  the  Branch 
Office  of  his  district  before  10 :00  A.  M.,  in 
order  to  receive  assignments  for  the  day. 

(3)  Special  cases  are  given  to  him  after  assign 

ing  hour  by  the  Branch  Office,  and  after 
office  hours  by  the  Borough  Office  through 
the  telephone. 

(4)  Before    leaving    district    he    calls    Branch 

Office  by  telephone  to  receive  cases  and 
report  on  special  cases  (for  removal,  for 
instance). 

(5)  He  again  calls  up  the  Branch  Office  before 

the  closing  hour  of  the  latter. 

(6)  Relief — In  order  to  be  relieved  from  duty 

temporarily  a  district  diagnostician  may 
make  arrangements  with  another  Diagnos- 
tician to  take  his  work,  but  before  absent- 
ing himself  must  notify  the  Branch 
Office,  which  will  in  turn  notify  the  Bor- 
ough Office. 

B. — He  performs  immunization  for  diphtheria  on 
request  of  nurses  or  others  (if  possible  at  hour  sug- 
gested). If  unable  to  obtain  consent  to  immunize,  he 
will  make  every  effort  to  have  the  same  performed  by 
the  private  physician. 

62 


O. — He  examines  and  makes  out  removal  slips  for 
ases  requiring  removal  to  hospitals.  Also  informs 
amily  of  destination  of  ease,  together  with  address 
nd  telephone  number  of  the  hospital. 

D. — He  diagnoses  cases  on  the  request  of  private 
hysicians  and  Department  nurses,  and  such  other 
ases  as  are  in  dispute. 

E. — He  investigates  cases  of  cerebro-spinal  menin- 
itis  and  poliomyelitis,  secondary  visits  being  made  by 
urses. 

F. — He  investigates  absences  of  Department  em- 
■loyees. 

G. — He  issues  special  school  certificates. 

DISTRICT   NURSES. 
INSTRUCTIONS. 

ON    FIRST    VISIT. 

!ee.  53. 

1.  Locate  janitor  and  inquire  if  anyone  in  the  build- 
ng  is  sick  with  any  infectious  disease  and  without  a 
>hysician  in  attendance. 

2.  On  arrival  at  apartment  of  patient     . 

(a)  Inspect  quarantine; 

(b)  Get  necessary  data  for  history  card  (20  J)  ; 

(c)  Exclude  teachers  and  scholars,  make  out 
exclusion  postal  card  (Form  14  J)  and 
inform  family  that  teachers  and  pupils 
must  not  attend  any  schools ; 

(d)  Note  on  history  card  (20  J)  whether  case 
Is  for  observation  or  supervision ; 

G3 


(e)  Ascertain  what  members  of  the  family  have 

had  this  disease.     Enter  same  on  history 
card ; 

(f)  State   number    to   be    immunized   and    by 

whom ; 

(g)  Deliver  hanging  card  calling  attention  t' 

details  relating  to  this  case ;  j 

(h)  Where  rooms  are  back  of  store  or  entranr ( 
to  same  is  through  the  store,  inform  fain  ■ 
ily  that  store  must  be  closed  or  case  re-| 
moved  to  hospital ; 

(i)   Ascertain    the   occupations    of   members    c»i 
family;  teachers  and  persons  engaged  ini 
handling  of  foods  must  change  address  or  I 
stop  work ;  it  is  necessary  for  teachers  to 
have  special  school  certificates  in  order  to 
re-enter  school ; 

(j)   If  manufacturing  is  being  done  in  a  home, 
where  there  is  infectious  disease,  direct] 
family  to  stop  same,  notify  Branch  Ofiice, 
and  order  disinfection  of  goods; 

(k)  If  illness  is  in  family  of  superintendent  or 
janitor,  inform  him  he  must  stop  work  or 
reside  elsewhere ; 

(I)  Post  placard  in  tenement  houses,  lodging 
houses,  boarding  houses,  furnished  room 
houses  and  two-family  houses  with  com- 
mon entrance; 

(m)  Take  cultures  from  patient  and  other 
members  of  the  household,  only  when  re- 
quested. 

64 


ON  REVISITS. 

ec.  54. 

1.  Determine  if  quarantine  is  observed.  If  not  ob- 
2rvecl,  warn  family  and  notify  Brancti  Office.  In  case 
f  second  violation,  telephone  Branch  Office. 

2.  Ascertain  if  secondary  cases  have  appeared  in  the 
imily;  if  so  report  to  Branch  Office  as  a  suspected 
ase. 

FINAL    VISITS. 

ec.  55. 
A. — DipJitheria. 

1.  Quarantine  7  days. 

2.  If  two  successive  negative  cultures  have  been 

taken  by  the  attending  physician  (or  by 
employee  of  the  Department  of  Health) 
remove  placard  and  instruct  family  re- 
garding renovation. 

3.  Issue  school  certificates  as  follows : 

To  patient  if  a  school  child ; 

To  teachers  and  pupils  who  have  been  im- 
munized and  whose  cultures  are  negative, 
otherwise  wait  five  days. 
B.    Scarlet  Fever. 

1.  Quarantine  3,5  days,  or  until  patient  is  free 

from  desquamation  (Examine  palms  and 
soles  carefully)  and  there  is  no  purulent 
discharge  from  the  nose  or  the  ear. 

2.  Order  fumigation.      (Investigate  for  library 

and  school  books.) 

3.  Reinspect  fumigation. 

4.  Issue  school  certificates  as  follows : 

To  patient  if  a  school  child ; 
To  teachers  and  pupils  who  have  had  scarlet 
fever;  otherwise  wait  five  days. 

65 


C.    Measles. 

1.  Quarantine  5  days  after  appearance  of  rasl 

if  otherwise  well.     (Look  for  absence  o 
catarrhal  conditions.) 

2.  Instruct  as  to  renovation. 

3.  Remove  placard. 

4.  Issue  school  certificates  as  follows : 

To  patient  if  a  school  child ; 

To    teachers    and    pupils    who    have    ha 
measles ;  otherwise  wait  fourteen  days. 

GENERAL    INSTRUCTIONS    FOR    NURSES. 

Sec.  56. 

1.  Never  examine  a  patient  except  to  terminate  scar- 
let fever. 

2.  Never  comment  on  treatment  or  condition  of  pa- 
tient. 

3.  Never  take  cultures  unless  requested  by  family 
physician  or  Branch  Office. 

4.  Make  every  effort  possible  to  have  all  exposed  to 
diphtheria  promptly  immunized. 

5.  If  quarantine  is  violated  or  not  satisfactory,  re- 
port same  to  Branch  Office  and  note  same  on  history 
card  20  J. 

NOTIFICATION  AND  REGISTRATION. 

Sec.  57.  The  procedure  for  notification  and  registra- 
tion has  already  been  described  (Sees.  38,  39).  Every 
case  reported  is  acknowledged  by  postal  (Form  35  J). 

Any  departure  from  the  general  procedure  will  be 
taken  up  under  the  individual  diseases. 

66 


SANITARY  SUPERVISION. 

INSPECTION    OF    CASES. 

Sec.  58.  Nurses  make  all  visits  to  cases  of  eonta- 
ious  diseases  except  those  for  diagnosis  and  the  jQrst 
isit  to  cases  of  cerebro-spinal  meningitis,  and  acute 
(oliomyelitis ;  these  visits  are  made  by  the  district 
iagnostician. 

Upon  arrival  at  the  case  the  inspector  or  nurse 
:11s  out  a  history  card  (20  J),  inspects  arrangements 
or  isolation,  excludes  susceptible  children  or  teach- 
rs,  gives  verbal  instructions  and  leaves  a  hanging 
ard  of  general  information  about  the  disease. 
Form  270,  271  or  272  L).  This  card,  printed  in  four 
inguages,  particularly  emphasizes  the  manner  in 
|/hich  the  disease  is  spread  and  the  steps  necessary  for 
ts  efficient  isolation. 

CLASSIFICATION  OF  CASES. 
Sec.  59.    Cases  are  visited  sufficiently  often  to  main- 
ain  proper  quarantine,  and  are  classified,  according 
0  the  ability  of  the  family  to  appreciate  and  main- 
ain  satisfactory  isolation,  into : — 

A.,  Supervision  Gases,  which  require  visits  every 
ay  or  every  few  days,  and, 

B.,  01)servation  Cases,  which  require  only  occasional 
isits. 

The  occupation  of  other  members  of  the  family  is 
Qvestigated  with  reference  to  the  character  of  their 
7ork.  The  dangers  of  spreading  disease  may  be 
reatly  increased  because  of  the  nature  of  the  work 
[one  in  the  home,  or  because  of  the  character  of 
he  employment  of  members  of  the  family  outside 
he  home.    Members  of  the  family  are  forbidden  to 

67 


continue  such  home  occupations  as  tailoring,  dress 
making,  feathermaking,  etc.,  or  to  engage  in  any  waj 
in  the  handling  of  foodstuffs. 

PLACARDING. 

Sec.  60.  Cases  of  Diphtheria,  Scarlet  Fever  anc 
Measles  occurring  in  tenement  houses,  furnished  rooms 
and  boarding  houses,  and  two-family  houses  with  com 
mon  entrance,  are  placarded  (Diphtheria,  Form  47  J 
Scarlet  Fever,  Form  44  J;  or  Measles,  Form  120  J) 
Private  houses  and  two-family  houses  with  separate 
entrances  are  not  placarded.  The  placard  in  tenemeul 
houses  is  placed  on  the  door  of  entrance  from  the  pub 
lie  hall ;  in  furnished  room  houses,  boarding  houses 
etc.,  on  the  door  of  the  sick-room,  and  in  the  two 
family  houses  with  common  entrance,  upon  the  dooi 
leading  from  the  common  hall  to  the  infected  apart 
ment. 

On  Sundays  and  Holidays,  all  new  cases  of  diph 
theria  and  scarlet  fever  are  placarded  by  districi 
nurses. 

QUARANTINE. 

Sec.  61.  The  rules  of  quarantine  are  discussed  un 
der  the  individual  diseases.  Violations  of  these  rulef 
will  lead  to  forcible  removal. 

A  placard  of  instructions  (Form  282  L)  is  issued  foi 
hotels  and  boarding  and  lodging  houses. 

CHARITABLE     ASSISTANCE     AND     EDUCATION 
OF  PUBLIC. 

Sec.  62.  Charitable  assistance  or  hospital  care  is 
provided,  so  far  as  is  possible,  for  all  cases  wishing 
or  requiring  such  assistance  or  care. 

68 


The  general  public  is  educated  as  to  the  nature  of 
he  infectious  diseases,  the  precautious  to  be  taken 
gainst  their  spread,  the  advisability  of  institution 
nd  sanatorium  treatment,  etc. 

The  Bureau  issues  a  small  booklet  of  information 
or  physicians,  giving  the  procedure  in  infectious  dis- 
ases,  with  a  list  of  supply  stations  (Form  206  L), 
nd  a  circular  of  information  for  school  children  re- 
arding  infectious  diseases  (Form  216  L). 

ENFORCED  REMOVAL  TO  HOSPITAL. 

:  Sec.  63.  Should  a  case  of  infectious  disease  be  found 
[i  a  home  in  the  rear  of,  or  communicating  with  a 
i:ore,  the  family  is  given  the  choice  of  closing  the 
:ore,  or  of  permitting  the  removal  of  the  case  to  the 
;Ospital. 

I  When  violations  of  quarantine  are  observed  by  an 
ispector  or  nurse,  the  Branch  Office  notifies  the 
orough  Office  of  this  violation  by  telephone,  confirm- 
ig  the  same  by  written  report.  The  case  is  then 
Lsited  by  a  patrolman  of  the  Health  Squad,  who 
arns  the  family  that  if  proper  quarantine  is  not 
aintained,  the  patient  will  be  removed.  The  Branch 
ffice  telephones  this  information  to  the  attending 
lysician  and  solicits  his  aid  in  maintaining  isola- 
)n.  The  case  is  made  a  Supervision  Case  and  upon 
port  of  a  second  violation,  removal  is  recommended. 
s])Ocial  report  (Form  17  J)  stating  the  character  of 
('  violation  is  submitted  to  the  Physician-in-charge, 
lio  forwards  it  through  the  Borough  Office  to  the 
I  iff  of  Division,  When  approved  by  the  latter,  the 
trough  Chief  is  authorized  to  remove  the  case.  He 
'tifies  a  stable  of  the  Department  of  Health,  and  an 

G9 


ambulanee  is  sent  for  the  patient.     When  necessarj_ 
the  ambulance  surgeon  is  aided  by  a  policeman. 

All  removal  cases  are  visited  by  a  district  diai 
nostician  who  confirms  diagnosis  before  sending  patiei 
to  hospital  and  leaves  a  removal  card  (Form  10  J 
for  the  ambulance  surgeon,  at  the  patient's  home. 

TERMINATION  OF  CASES. 

Sec.  64.  Cases  are  terminated  by  recovery,  deat] 
removal  to  hospital,  or  change  of  diagnosis  (on  rt 
ceipt  of  written  statement  from  the  physician  thi 
original  diagnosis  was  in  error).  Inspection  is  madi 
to  order  fumigation,  to  give  instructions  as  to  rem 
vation;  to  issue  school  permits  and  to  remove  pla 
ards. 

DEATHS  FROM  INFECTIOUS   DISEASES. 

Sec.  65.  All  deaths  from  infectious  diseases,  inclu< 
ing  typhoid  fever,  tuberculosis,  whooping  cough,  et( 
are  reported  by  death  certificates  submitted  to  tl 
Bureau  of  Records  of  the  Department  of  Health.  Ui 
dertakers  must  also  certify  (Form  41  J)  that  all  pr 
cautions  have  been  talien. 

A. — Procedure  in  Bureau  of  Records. 

If  death  certificate  is  received  during  office  houi 
of  the  Department,  it  should  be  at  once  referred  to  tl 
Bureau  of  Infectious  Diseases  for  comparison  wil 
records,  and  "O.  K."  and  signature  by  the  officer  i 
charge  of  the  Borough  Office  of  that  Bureau.  Tl 
burial  permit  will  then  be  issued. 

If  certificate  is  received  before  or  after  Depar 
mental  office  hours,  it  is  forwarded  to  the  Bureau  < 
Infectious  Diseases,  the  morning  of  the  next  workii 

70 


Jay.     In  cases  of  diphtheria    (croup),  scarlet  fever, 
measles,  cerebro-spinal  meningitis  and  acute  poliomye- 
litis, the  medical  clerk  should  ascertain  from  under- 
taker if  case  was  reported  to  Department  of  Health 
luring  life.     (In  case  of  diphtheria,  scarlet  fever,  and 
measles,    placards    should    have    been    posted.)       (a) 
yVhere  case  has  been  previously  reported,  and  where 
;he  Department  of  Health  will  be  open  the  following 
lay,  the  burial  permit  should  be  issued,  and  death  cer- 
ificate  sent  to  Bureau  of  Infectious  Diseases  as  early 
IS  possible  the   following   morning   for   "O.   K."   and 
•eturn.     If  the  next  day  is  a  Sunday  or  holiday,  the 
iClephone  operator  should  be  requested  to  assign  the 
;ase  in  the  morning  to  the  proper  district  diaguosti- 
ian,  certificate  being  sent  to  the  Bureau  of  Infectious 
diseases  for  "O.  K."  on  the  following  working  day. 
Note :  The  clerk-in-charge  of  the  Borough  Office  of 
he  Bureau  of  Infectious  Diseases  inquires  at  the  local 
ffice  of  the  Bureau  of  Records  each  morning  at  9:00 
L.   M.   for   such   certificates.)      (b)    Where   case   has 
robably  not  been  reported  during  life,  a  Sanitary  Po- 
iceman  should  be  immediately  sent  to  placard  prem- 
ies (the  Bureau  of  Infectious  Diseases  will  supply  the 
►ureau   of   Records   with    the    necessary   placards), 
'hen  proceed  as  in  (a). 

B. — Procedure  in  Bureau  of  Infectious  Diseases: 
Burial    certificates   must   receive   immediate   atten- 

on  and  be  returned  to  the  Bureau  of  Records  as 

>on  as  possible. 

(\i)  Deaths    in    cases    previously    reported    during 

—All  deaths  reported  on  any  morjiing  by  death 

■iiifi<ato  are  to  be  promptly  assigned  to  the  proper 

ruijch   Office  for  investigation  by  a  district  nurse. 

71 


All  deaths  reported  after  9  :00  A.  M.,  and  before  4 :0 
P.  M.  should  be  at  once  assigned  to  Branch  Offio 
for  immediate  investigation  by  nurse  or  district  dia.i 
nostician,  if  the  former  is  not  obtainable.  Deaths  re 
ported  after  4:00  P.  M.,  where  following  day  is 
working  day  need  not  be  assigned  until  the  nes 
morning.  When  the  next  day  is  a  Sunday  or  holiday 
cases   should  be  assigned  immediately. 

(b)  Deaths  in  cases  not  previously  reported  dur'in 
life: — These  cases  call  for   immediate  investigation. 

C. — Duties  of  Investigator :— The  nurse  or  distrii 
diagnostician  of  the  Bureau  of  Infectious  Disea^^<^^ 
visits  the  premises  where  the  death  has  occurred,  {ui 
makes  sure  that  in  cases  of  diphtheria  (croup),  scarh 
fever,  measles,  cerebro-spinal  meningitis,  and  acui 
poliomyelitis,  the  following  regulations  of  the  Deparj 
ment  are  complied  with : — 

(a)  That  the  remains  are  in  a  casket,  and  th 
casket  closed  and  sealed  with  the  official  seal  of  th 
Department  of  Health.     (Form  13  HH.) 

(b)  That  funeral  is  private,  and  takes  place  withi 
24  hours. 

(c)  That  premises  are  placarded. 

(d)  That  in  cases  of  diphtheria,  other  children  hsi\ 
been  immunized  or  offered  immunization. 

(e)  That  susceptible  school  children  and  teachei 
are  excluded  from  school. 

(f)  Inquiry  as  to  occurrence  of  secondary  cases 
made.  A  history  card  must  be  made  out  for  each  cas 
not  previously  reported  during  life.  The  date  ( 
death,  date  of  burial,  and  name  of  the  undertaker  ai 
noted  thereon.     Prompt  fumigation  of  infected  roon 

72 


is  ordered  and  a  report  is  made  in  writing,  stating  how 
long  patient  bas  been  ill  and  under  the  care  of  an 
attending  physician. 

D. — Regulations  Regarding  Bodies  Removed  From 
City: 

In  deaths  from  infectious  diseases  where  remains 
are  to  be  shipped  outside  of  New  York  City  by  rail 
or  boat,  a  representative  of  the  Bureau  of  Infectious 
Diseases  must  (a)  determine  who  may  accompany  the 
body  to  the  place  of  interment  or  cremation,  and  (b) 
make  sure  that  the  body  is  properly  prei)ared  and 
placed  in  a  metal-lined,  hermetically  sealed  casket 
as  required  by  the  Federal  and  State  regulations. 

"NOT  FOUND  CASES." 

Sec.  66.  When  a  case  cannot  be  found  at  the  ad- 
dress given,  and  the  attending  physician  cannot  be 
2onmiunicated  with  by  telephone,  a  patrolman  of  the 
Health  Squad  is  sent  to  the  physician's  office  to  obtain 
the  corrected  address. 

EXCLUSION  FROM    SCHOOiL. 

Sec.  67.  Other  children  or  teachers  in  the  family 
tvho  have  not  had  the  disease  are  excluded  from 
school,  and  if  they  remain  on  the  premises  until 
termination  of  the  case,  cannot  return  to  school  until 
I'he  expiration  of  the  incubation  period  of  the  disease. 
\  i)rinted  list  showing  all  the  new  cases  of  contagious 
liseases  for  that  date  is  sent  daily  to  all  public  and 
oarochial  schools.  If  any  member  of  the  family  at- 
tends a  city  college,  or  public,  private  or  parochial 
school,  an  official  exclusion  postal  card  (14  J)  must 
be  filled  out  and  mailed  to  the  school. 


PERMITS   TO   RETURN  TO    SCHOOL. 
Sec.    68.    Are   issued    to    teachers    or   children    o 

receipt  of  evidence  (Form  7  J)  of  previous  attack  i 
the  disease  providing  quarantine  is  satisfactory  t 
the  address  has  been  changed.  Also  to  susceptibl 
children  who  have  resided  at  a  new  address  for  th 
period  of  incubation  of  the  disease  in  question. 

SMALLPOX,   CHOLERA,   PLAGUE,   YELLOW 
FEVER  AND  TYPHUS  FEVER. 
Sec.    G9.     The   Department   of  Health   immediate!' 
assumes  full  charge  in  all  cases  of  the  above  diseas. 
the  Chief  Diagnostician   being  responsible   for   the 
proper  investigation  and  care. 

A   popular   leaflet    (Form   170  L)    advising   vaccinr. 
tion  against  smallpox  is  issued. 

MANAGEMENT  OF  SMALLPOX  BY  THE  DEPART 
MENT  OF  HEALTH. 
Sec.  70.    Upon  receipt  by  Borough  Office  of  notifica^ 
tion  of  a  case  of  smallpox,  from  a  physician  or  other 
reliable  source,   the  case  is  at  once  assigned  to  the 
proper   District    Diagnostician.     The    Chief    Diagnos- 
tician is  notified  by  telephone.   The  telephone  operator 
also  (a)  requests  the  police  precinct  of  the  district  to 
send  a  patrolnian  to  meet  the  diagnostician;  (b)  upon 
corroboration  of  the  diagnosis  by  the  Chief  Diagnos- 
tician, notifies  the  ambulance  station  to  send  an  am- 
bulance for  removal  of  the  patient;   (c)  sends  a  dis- 
infector   to   disinfect  the  premises,   and    (d)    notifies 
the  ofl^ces  of  the  Commissioner  of  Health,  the  Sani- 
tary Superintendent,  the  Health  Oflicer  of  the  Port  of 
New  York,  and  the  Director,  Chief  of  Division  of  Con- 


74 


igious  Diseases,  and  Borough  Chief  of  the  Bureau  of 
afeetious  Diseases,  of  the  existence  of  the  ease. 

DUTIES   OF   DIAGNOSTICIANS: 

CASES   OF   SMALLPOX. 

Sec.  71.    The  diagnostician  must  give  such  assign- 
lents  precedence,  and  visit  them  as  speedily  as  pos- 
ible.     Should  the  case  prove  to  be  smallpox,  and  re- 
loval  has  not  been  ordered,  he  must  at  once  request 
he  telephone  operator  to  send  policeman  and  disin- 
iector,  order  removal  and  notify  authorities  as  above 
tated.    The  diagnostician  obtains  a  complete  history 
^Form  109  J)  for  the  three  weeks  previous  to  the  first 
lanifestation  of  the  disease,  carefully  including  a  list 
k  all  places  visited  by  the  patient ;  inquires  as  to  vac- 
ination,  obtains  the  addresses  of  all  places  visited  by 
he  patient  since  the  onset,  takes  the  names  and  ad- 
Iresses  of  any  visitors  present,  and  informs  all  persons 
n  the  building  of  the  presence  of  the  disease.    If  the 
latient   is   engaged   in   any   occupation,  his   place   of 
lusiuess  is  immediately  visited  by  the  diagnostician, 
vho  takes  the  names  and  addresses  of  all  persons  who 
lave  been  associated  with  him,  and  informs  them  of 
;he  presence  of  smallpox. 
Before  leaving,  the  diagnostician  visits  all  rooms  of 

he  house  to  ascertain  if  there  be  other  cases  on  the 
3remises,  gives  instructions  for  the  removal  of  the 
patient,  orders  fumigation  and  removal  of  bedding, 
md  leaves  data  for  the  ambulance  surgeon  and  dis- 
infector.  The  police  officer  is  usually  left  in  charge 
of  the  case  until  the  arrival  of  the  ambulance.  (All 
cases  of  smallpox  are  removed  to  the  Reception  Hos- 
pital of  the  Department  of  Health,  regardless  of  the 

7^ 


stage  of  the  disease.    Bodies  of  those  dead  from  small 
pox  are  removed  to  the  Department  Morgue.) 

After   removal   of   the  patient  from   the   premises; 
the   District   Diagnostician   requests    headquarters   t( 
send  a   supply   of   vaccine   by   a   sanitary  patrolman  i 
On  the  arrival  of  the  same,  he  offers  vaccination  tc 
all    who   have   been    exposed.     The   police   officer    acjj 
companies  him,  and  assists  him  whenever  necessary! 
Occupants   absent   during  the  day  are   vaccinated  at 
night.     When   vaccination   is   completed,    the   District^ 
Diagnostician  forwards  to   the  Borough   Office  a   lisl, 
of  all  those  vaccinated.     ( Note :  A  copy  of  this  list  is 
sent  to  the  Bureau  of  Child  Hygiene  for  vaccination 
card  record.)     On  his  initial  visit  he  excludes  from 
school    all    children    and    teachers    who    have    been 
exposed,   notes   the   location  of  the   schools   attended 
and    notifies    the    principals.     At    the    end    of    three 
weeks,  if  no  secondary  cases  have  appeared,  he  is- 
sues   certificates    allowing    children    and    teachers    to 
return  to  school. 

The  District  Diagnostician  visits  the  premises  daily 
for  a  period  of  three  weeks  to  ascertain  if  there  be 
any  secondary  cases.  He  keeps  a  record  of  these  visits, 
giving  date,  number  of  people  exposed  and  number 
vaccinated  on  a  subsequent  visit  card.  (Form  110  J.) 
Should  any  person  or  family  move  while  the  house  is 
under  surveillance,  the  new  address  is  obtained  and 
surveillance  at  the  latter  address  continued  for  the 
regulation  period.  Should  he  find  a  secondary  or  sus- 
pected case,  he  immediately  notifies  the  Department 
of  Health  by  telephone.  Should  a  case  of  smallpox 
appear  in  an  institution  where  children  are  committed, 
the  Department  of  Health  establishes  quarantine  for 

76 


n    period   of   twenty-one   days   after   the   removal    of 
latest  case. 

The    District    Diagnostician    forwards    a   detailed 

written  report  of  each  case,  in  addition  to  his  daily 

summary.     Daily  progress  reports  are  forwarded  by 

.the  Borough  Chief  as  long  as  vaccination  is  in  progress. 

'  CHOLERA,  PLAGUE,  AND  YELLOW  FEVER. 

Sec.  72.  Upon  report  of  any  of  the  above  diseases, 
every  known  precaution  in  diagnosis  and  quarantine 
is  taken.  « 

TYPHUS    FEVER. 

Sec.  73.  All  reported  cases  of  typhus  fever  are  im- 
mediately removed  to  the  Reception  Hospital  of  the 
Department  of  Health.  Premises  fumigated  and  bed- 
ding disinfected. 

[Note. — Cases  of  modified  typhus  fever  (Brill's 
[Disease)  are  not  removed  to  a  hospital  by  the  Depart- 
[ment  of  Health.  The  Health  Ofiicer  of  the  Port, 
however,  treats  these  cases  as  true  typhus  fever  and 
requests  that  the  Department  of  Health  of  New  York 
T'ity  follow  up  all  passengers  and  take  the  precautions 
usual  in  this  disease,] 

DIPHTHERIA. 

GENERAL  INFORMATION. 

Sec.  74.  Incubation  period  1-5  days.  Quarantine 
period  7  days. 

If  the  diagnosis  depends  upon  a  culture  alone,  and 
fhe  culture  is  negative,  the  case  is  not  considered  diph- 
theria ;  cases  reported  by  postal  card  are  considered 
as  diphtheria,  unless  otherwise  requested,  even 
though  cultures  are  negative. 

77 


A  district  nurse  must  see  each  case  of  diphtheria 
the  day  it  is  referred  to  her ;  upon  her  first  visit,  upon 
request  of  the  attending  physician  she  takes  a  culture 
from  the  patient's  nose  or  throat,  unless  this  has  al- 
ready been  done  by  the  district  diagnostician.  Trial 
cultures  should  be  made  from  all  members  of  the  fam- 
ily by  the  private  physician  or  district  nurse,  in  order 
that  carriers  may  be  Immunized  against  the  disease 

If  quarantine  is  observed  or  address  changed,  chil- 
dren and  teachers  who  have  been  immunized  and 
cultures  from  whose  nose  and  throat  are  negative 
may  return  to  scbool.  If  not  immunized  and  no  neg- 
ative cultures  have  been  obtained,  even  though  the 
address  be  changed,  school  permits  are  not  issued  for 
seven  days.  If  they  remain  at  original  address  until 
case  is  terminated,  school  permits  are  not  given  until 
seven  days  after  the  latest  case  in  the  family  has 
been  terminated  by  the  Department  of  Health.  All 
these  cases  require  a  special  school  certificate  (Form 
7  J)  which  is  issued  by  the  Borough  Chief,  District 
Diagnostician,  or  Physician  in  charge. 

School  certificates  (Form  7  J)  are  issued  to  recov- 
ered cases  upon  termination.  Immunization  of  all 
other  members  of  the  family  is  recommended,  and  will 
be  done  by  the  District  Diagnostician,  all  arrange- 
ments being  previously  made  by  the  nurse. 

DIPHTHERIA     ANTITOXIN. 

Sec.  75.  The  administration  of  curative  doses  of 
antitoxin  and  the  performance  of  intubation  for  laryn- 
geal diphtheria,  are  done  only  in  cases  which  are  to 
be  at  once  removed  to  a  Department  Hospital.  An- 
titoxin can  be  obtained  free  by  physicians  at  any  of  ' 

78 


le  supply  stations  of  the  Department  (see  Directory), 
the  physician  certify  tliat  the  patient  is  unable  to 
ly  for  it.  In  Manhattan,  antitoxin  in  syringe-con- 
iners  is  delivered  by  a  motorcycle  policeman  to  the 
itient's  house  on  receipt  of  a  telephone  request  at 
le  Borough  Office  from  the  physician. 

DIPHTHERIA   ANTITOXIN   IN    SYRINGE-CON- 
TAINERS,—ALL-NIGHT     STATIONS. 

Sec.  76,  Antitoxin  in  syringe-containers  [Informa- 
on  card  for  physicians  (Form  2  J)]  can  also  be 
)tained  at  the  following  all-night  drug  stores: 

MANHATTAN. 

Teau — 116th  Street  and  3rd  Avenue. 
International  Dbug  Co. — 1128  Third  Avenue. 
GoLDLusT — 1566  Third  Avenue. 
Walker — Broome   and   Ludlow   Streets. 

BROOKLYN. 

Pfistee  &  SiTTERLEY — Fultou  Street  and  Nostrand 
venue. 

R/EiD — 135  Sands  Street. 
Lamb — 84  Court  Street. 
BoHLK — Gates   Avenue    and   Broadway. 
Wilson  &  Israelson — Graham  Avenue  and  Boerum 
treet. 

RICHMOND. 

LocKwooD  &  CoLTON — Water  Street,  Stapleton. 

TERMINATION  OF  CASES  OiF  DIPHTHERIA. 

Sec.  77.  No  case  is  terminated  until  at  least  two 
iccessive   cultures,   preferably   from   both   nose   and 

79 


throat,  taken  not  less  tlian  24  hours  apart,  show 
absence  of  diphtheria  bacilli. 

DIPHTHERIA  CARRIERS. 

Sec.  78.  Persons  harboring  diphtheria  bacilli  wl 
show  no  evidence  or  give  no  history  of  clinical  sym] 
toms  of  diphtheria,  are  known  as  "carriers"  and  ai 
isolated  in  the  place  where  found  until  the  virulen< 
of  the  bacilli  present  is  determined.  Virulent  cast 
are  likewise  terminated  by  two  consecutive  negati\ 
cultures  from  nose  and  throat,  taken  not  less  tha 
24  hours  apart. 

These  cases  are  not  removed  to  a  De])artment  hoi 
pital  unless  it  is  impossible  to  maintain  quarantin 
where  the  case  is  located. 

For  regulations  governing  school  exchision  and  reac 
mission,  placarding,  removal  to  hos])ital  and  fum 
gation  see  Sees.  53,  55,  (JO,  Gl,  04,  07,  08  and  90. 

SCARLET  FEVER. 

Sec.  79.  Incubation  period  2-5  days.  Quarantin 
period  35  days  providing  desquamation  is  complet 
and  discharges  from  nose  and  ears  have  ceased. 

For  regulations  governing  school  exclusion  and  re 
admission,  placarding,  removal  to  hospital  and  fumi 
gation  see  Sees.  53,  55,  00,  01,  04,  07,  08,  90. 

MEASLES. 

Sec.  80.  Incubation  period  12-14  days.  Quarantiiw 
period  five  days  after  appearance  of  eruption  if  m 
catarrhal  discharges  are  present,  cough  has  stoppet 

80 


11(1  patient  is  otiierwise  well.  On  August  15th,  1913, 
iie  quarantine  period  for  measles  was  reduced  to  five 
ays  after  the  appearance  of  the  eruption.  That  this 
rocedure  was  justified  is  evidenced  b5'  the  fact  that 
I  here  has  been  no  increase  in  the  occurrence  of  sec- 
,  ndary  cases. 

!    For  regulations  governing  school  exclusions  and  re- 
(  dmission,  placarding,  removal  to  hospital  and  fumi- 
gation see  Sees.  53,  55,  60,  61,  64,  67,  68,  96. 
I 

SOCIAL  SERVICE  AMONG  HOSPITAL  CON- 
VALESCENTS. 

'  Sec.  81.  All  cases  of  scarlet  fever,  diphtheria  and 
beasles  discharged  from  the  hospitals  of  the  Depart- 
nent  of  Health  are  revisited  by  the  district  nurse  of 
(-he  Bureau  of  Infectious  Diseases,  to  determine  the 
•ondition  of  the  patient  after  being  discharged  (as  to 
nfectivity,  etc.),  and  the  home  conditions  of  the  fam- 
ly.  Advice  is  given  as  to  the  care  of  the  convalescent 
latient,  and,  if  necessary,  the  family  is  referred  to 
:he  proper  charitable  organization  for  financial  aid 
md  other  assistance.  At  least  one  additional  visit  is 
made  after  the  expiration  of  the  incubation  period  of 
the  disease  in  question,  to  ascertain  if  any  secondary 
•[ises  have  developed. 

The  names  and  addresses  of  all  such  cases  are  tel- 
L'])honed  daily  to  the  office  of  the  Chief  of  the  Division 
i)f  Contagious  Diseases  and  entered  on  special  cards 
fForm  251  L)  and  forwarded  through  the  Borough 
Office  to  the  proiier  Branch  Office. 

The  card  is  assigned  to  the  district  nurse  in  the 
usual  way.     When  returned,  after  the  first  visit,  it  is 

81 


filed  in  the  "tickler"  file  for  revisit  at  the  expiratio 
of  incubation  period.  Cards  are  then  returned  to  th 
Office  of  the  Division  of  Contagious  Diseases  fc 
tabulation  and  thence  to  the  Borough  Office  for  fins 
filing  in  the  envelope  of  the  case.  The  weekly  repot 
of  the  Branch  Office  states  the  number  of  convales 
cents  under  observation,  of  revisits  to  same,  and  o 
secondary  cases  found. 

The  nurse  reports  on  the  card  as  to: — 

(a)  the  general  physical  condition  of  patient. 

(b)  the  existence  of  desquamation  or  discharge 
from  the  nose  or  ears,  of  ulcers  or  sores,  am 
the  condition  of  the  throat. 

(c)  the  home  conditions  of  the  family,  an( 
whether  patient  is  obtaining  proper  food  am 
care.  If  not.  reference  to  a  charitable  or 
ganization  is  recommended. 

At  the  second  visit  the  nurse  inquires  as  to  the  oc 
currence  of  any  secondary  cases  of  the  disease  ii 
question. 

CEREBRO-SPINAL    MENINGITIS. 

Sec.  82.  Incubation  period  one  to  five  days.  Quar- 
antine period  two  weeks  from  onset. 

Upon  receipt  at  the  Borough  Office  of  notification  ol 
a  case  of  Cerebro-Spinal  Meningitis,  the  name  and 
address  of  the  patient  and  the  source  of  the  report 
are  immediately  telephoned  to  the  Research  Labora- 
tory. The  case  is  then  assigned  through  the  Branch! 
Office  to  a  District  Diagnostician,  who  visits  it 
forthwith.     He  obtains  a  history   (Form  61 L)    with 

82 


ipecial  reference  to  source  of  infection,  and  gives 
lirections  as  to  isolation,  school  exclusion,  fumigation, 
jtc,  as  already  described  (See  Sees.  52,  54,  55,  61,  67, 
)8).  Upon  termination  of  the  case  the  history  is 
)romptly  referred  for  tabulation  to  the  Office  of  the 
Division  of  Typhoid  Fever. 

In  all  dead  cases  careful  inquiry  should  be  made 
0  ascertain  whether  the  disease  was  of  the  true  epi- 
lemic  type.  If  of  the  tuberculous  type  or  secondary 
0  other  disease,  the  District  Diagnostician  makes  a 
•eport  to  that  effect. 

Lumbar  puncture  for  diagnosis,  and  injection  of  anti- 
meningococcus  serum  will  be  performed  upon  request 
by  a  physician  from  the  Bureau  of  Laboratories. 

A  circular  of  information  (Form  196  L)  is  issued. 

ACUTE  POLIOMYELITIS. 

Sec.  83.  Incubation  period  two  to  five  days.  Quar- 
antine period  six  weeks  from  onset. 

Upon  receipt  at  the  Borough  Office  of  notification  of 
a  case  of  Acute  Poliomyelitis,  it  is  at  once  assigned 
through  the  Branch  Office  to  a  District  Diagnostician, 
who  visits  the  attending  physician  as  well  as  the  home 
of  the  patient,  and  obtains  a  complete  history  of  the 
case.  (Form  58  L).  He  gives  instructions  as  to  isola- 
tion, school  exclusion,  fumigation,  etc.  (See  Sees.  52, 
54,  55,  61,  67,  68.)  Each  case  is  reinspected  at  the 
end  of  three  months  from  date  of  onset,  and  again  at 
the  end  of  six  months,  to  obtain  data  as  to  final  dis- 
ability produced. 

Circulars  of  information  for  the  public  (Form  125 
L)  and  for  physicians  (Form  137  L)  are  issued. 

83 


MINOR    CONTAGIOUS    DISEASES. 


GENERAL  PROCEDURE. 


GERMAN  MEASLES,  MUMPS,  CHICKENPOX  ANI 
WHOOPING  COUGH. 
Sec.  84.  Upon  receipt  of  repoi-t  of  any  of  the  abovi 
diseases  a  card  of  instructions  printed  in  four  Ian 
guages  is  mailed  to  the  address  of  patient,  giving  in 
structions  as  to  tlie  precautious  to  be  obserA'ed,  anc 
duration  of  quarantine.  This  card  is  presented  at  th( 
school  upon  termination  of  illness.  In  private  schools 
cliildren  may  be  readmitted  on  certificate  of  private 
physician.  Children  who  have  had  the  disease  in  ques- 
tion may  continue  at  school ;  others  should  be  excluded 
for  the  period  of  incubation.  No  placarding,  fumiga- 
tion of  premises  or  disinfection  of  bedding  is  done. 

GERMAN  MEASLES. 

Sec.  85.  Incubation  period  two  weeks.  Quarantine 
period  one  week.  Instruction  card  (Form  24,  49,  .50 
or  51  J).  Cases  of  German  measles  often  simulate 
scarlet  fever.  In  doubtful  cases  physicians  are  en- 
couraged to  avail  themselves  of  the  services  of  the 
Diagnosticians  of  the  Department  of  Health. 

MUMPS. 

Sec.  86.  Incubation  period  three  weeks.  Quar- 
antine period,  until  swelling  has  subsided.  Instruction 
card  (Form  13,  52,  53  or  54  J). 

CHICKENPOX. 

Sec.  87.  Incubation  period  two  weeks.  Quarantine 
period  until  all  scabs  have  disappeared.     Instruction 

84 


aid  (Form  64,  65,  66  or  68  J).  In  all  cases  of 
hiekenpox  iu  adults,  the  diagnosis  must  be  confirmed 
y  a  Diagnostician  of  the  Department  of  Health. 

WHOOPING  COUGH,  INCUBATION  AND 
QUARANTINE. 

Sec.  88.  Incubation  period  two  weeks.  Quarantine 
eriod  until  the  whoop  has  disappeared.  Instruction 
ard   (Form  48,  55,  60  or  61J). 

WHOOPING   COUGH,    MANAGEMENT. 

Sec.  89.  Every  case  of  whooping  cough  living  in  a 
snement  house  is  visited  by  a  district  nurse.  Should 
he  family  include  an  infant  or  very  young  child  who 
as  not  as  yet  acquired  the  disease,  she  leaves  a  Cir- 
ular  of  Information  Regarding  Whooping  Cough 
Form  278  L) ,  advises  the  parents  of  its  danger  and  of 
he  precaution  that  must  be  observed.  She  keeps  the 
ase  under  close  observation.  If  these  precautions  are 
ot  or  cannot  be  observed  and  home  conditions  are 
ery  bad,  she  may  recommend  the  removal  of  the  child 
0  hospital  by  force  if  necessary.  But  as  a  rule  hos- 
italization  is  not  desired  except  (a)  as  an  extreme 
anitary  precaution  ;  (b)  for  research  purposes. 

In  some  cases  it  may  be  necessary  for  the  nurse  to 
Qform  all  other  families  in  the  house  of  the  existence 
t  whooping  cough  on  the  premises..  Early  cases  of 
irhooping  cough  not  under  medical  care  are  removed 
0  hospital  if  necessary.  Those  living  in  the  vicinity  of 
(^hooping  cough  clinics  are  urged  to  attend  such  clinics. 

General  dispensaries  are  allowed  to  conduct  whoop- 
ag  cough  clinics  if  they  comply  with  the  regulations 
f  the  Department  (Form  273  L). 

85 


OTHER   INFECTIOUS   DISEASES. 

TETANUS,     ANTHRAX,     GLANDERS,     LEPROSY     AND 
TRICHINOSIS. 

Sec.  90.  All  reported  cases  of  the  above  diseases  i 
human  beings  are  immediately  investigated  by  th 
Chief  Diagnostician. 

Injection  of  tetanus  antitoxin  is  performed  upon  n 
quest.  (Note:  During  the  period  immediately  pn 
ceding  and  following  the  Fourth  of  July,  district  diaj 
nosticians  carry  a  supply  of  antitoxin  to  meet  emei 
gency  cases.) 

MALARIAL  FEVER,  ERYSIPELAS  AND 
PNEUMONIA. 

Sec.  91.  Notification.  While  the  above  are  reports 
ble  diseases,  the  patients  are  at  present  not  visited  b 
a  diagnostician  or  nurse,  the  rejwrt  postal  (Form  5  J 
being  simply  acknowledged  (Form  129  L),  and  filed  fo 
statistical  reference,  and  tabulation.  History  blank 
have  been  prepared  for  pneumonia. 

DEATHS  FROM  MALARIA. 

Sec.  92.  All  deaths  reported  as  due  to  malaria  ar 
investigated  by  an  inspector,  who  visits  the  attendin 
physician,  to  inquire  if  case  w^as  not  really  one  o 
typhoid  fever,  if  blood  tests  were  made,  etc.,  and  n 
ports  on  a  special  card   (Form  175  L). 

ERYSIPELAS. 

Sec.  93.  Upon  request,  arrangement  for  the  r« 
moval  to  Bellevue  Hospital  of  cases  of  erysipelas  wil 
be  made. 

8a 


DISINFECTION. 


3ec.  94.  Premises  which  have  been  occupied  by 
•sous  suffering  from  infectious  diseases  are  fumi- 
ted  with  formaldehyde  or  renovations  ordered  (See 
2tion  52).  Bedding  is  removed  for  steam  steriliza- 
n  in  certain  cases  (see  Sec.  96). 
I 

REQUEST    FOR    DISINFECTION. 

5ec.  95.  Fumigation  is  ordered  by  the  dis'tricl 
'.'ses  or  diagnosticians  on  cards  (Form  232  L  for 
lerculosis,  Form  94  J  for  contagious  diseases). 
|ese  cards,  after  entry  of  facts  in  the  fumigation 
rnal  (Form  ILL)  at  Branch  Office,  are  forwarded 
the  Borough  Office  where  cases  are  assigned  to  dis- 
Bctors. 

i 

DISEASES  IN  WHICH  DISINFECTION  IS 
PERFORMED. 

ec.  96.  Fumigation  is  ordered  in  cases  of  small- 
:  and  scarlet  fever  upon  termination,  and  in  other 
K?tious  diseases  where  the  case  is  fatal,  or  patient 
removed  to  a  hospital  during  the  height  of  the 
ase. 
D  diphtheria  and  measles  when  patient  recovers, 

sick  room  is  thoroughly  cleaned  and  aired.  The 
)dwork  and  floors  of  the  room  are  scrubbed  with 
ition  of  one  pound  of  washing  soda  to  three  gallons 
bet  water.  Recommendation  is  made  that  night- 
ns,  sheets,  etc.,  be  first  soaked  in  carbolic  solu- 

and  then  boiled  in  soapsuds  for  one  half  hour, 
truction  of  books  and  toya  used  by  patient  is 
unmended. 

87 


In  cases  of  smallpox,  scarlet,  typhus,  cholera,  plag 
and  yellow  fever,  bedding  is  removed  for  steam  disj 
fection.  Otherwise  there  is  no  removal  of  bedding  e 
cept  upon  request  of  the  attending  physician. 

In  poliomyelitis  and  cerebro-spiual  meningitis  the 
is  no  fumigation  or  removal  of  goods,  but  renovati 
may  be  required.  In  fatal  cases,  or  removal  cas 
fumigation  is  ordered. 

In  mumps,  German  measles,  whooping  cough  a: 
chicken  pox  neither  fumigation  nor  removal  of  goo 
is  performed. 

In   tuberculosis,    fumigation    or   renovation   of 
premises  is  done,  following  death  or  removal  to  oth 
address.    There  is  no  removal  of  bedding  except 
special  request,  or  where  unusual  circumstances  cc 
nected  with  the  case  require  that  such  action  be  tak( 

In  typhoid  fever  disinfection  and  fumigation  are 
ordered  except  upon  special  request,  unless  the  circu: 
stances  of  the   case  demand  it. 

In  private  houses  and  hotels,  fumigation  may  be  do 
under  supervision  of  the  family  physician,  who  is  th 
required  to  furnish  a  certificate  to  that  effect  (Foi 
117  J). 

DISINFECTION   OF   BOOKS. 

Sec.  97.  Books  belonging  to  the  New  York  Pub 
Library  that  have  been  loaned  to  families  in  whi 
cases  of  diphtheria  and  scarlet-fever  occur,  are  remov 
by  a  wagon  of  the  Department  of  Health  on  recei 
of  a  return  postal  from  the  Library  requesting  SU' 
removal,  the  Library  being  notified  on  the  return  hf 
of  the  postal  that  the  books  have  been  removed. 

These  books  are  given  to  the  Department  of  Heal 

88 


'  the  Library  for  use  in  the  respective  diphtheria 
'  scarlet  fever  wards  of  the  Department  Hospitals. 

Books  from  families  in  which  cases  of  measles 
cur,  are  returned  to  the  Library  by  the  family  and 
moved  thence  by  the  Department  of  Health  at  regu- 
•r  intervals,  disinfected  with  formaldehyde,  and  re- 
'rned  to  the  Library. 

Books  loaned  to  families  in  which  a  case  of  small- 
!>x  has  occurred,  are  immediately  removed  and  de- 
royed. 

METHODS    OF    DISINFECTION. 

I 

[Sec.  98.     In  making  use  of  the  various  methods  of 

siufection,  the  availability  of  each,  and  its  inherent 

citations  should  be  kept  constantly  in  view,  as  for 

:ample.  the  fact  that  liquid  disinfectants  are  only 

fective  where  the  circumstances  permit  of  their  sys- 

matic  application  to  all  the  surfaces  to  be  treated, 

id  that  gaseous  disinfectants  are  only  of  use  for  sur- 

ce  disinfection. 

The  fact  is  strongly  insisted  upon  that  for  floors, 
loodwork  and  similar  surfaces,  soap,  hot  water  and 
scrubbing  brush,  thoroughly  used,  are  of  greater 
liciency  than  either  liquid  or  gaseous  disinfectants, 
;  the  latter  are  usually  employed ;  that  boiling  is  the 
;st  method  for  treating  all  fabrics  or  articles  not  in- 
:red  by  such  treatment,  and  that  full  aeration  and 
:posure  to  sunlight  must  be  regarded  as  of  primary 
iportance  in  all  cases. 

Inspectors  and  nurses  constantly  repeat  the  injunc- 
on  that  all  articles  use<l  about  the  patient  should 
i  boiled  or  otherwise  disinfected  as  often  as  used; 

89 


that  all  discharges  from  tbe  nose,  mouth,  bladder  aii 
bowels  must  be  immediately  disinfected  or  destroys; 
and  that  tliese  things,  assisted  by  scrubbing,  sunnijg 
and  airing  of  the  sick  room,  and  by  personal  cleai- 
ness  and  frequent  hand-washing  by  the  attendan 
greatly  lessen  the  danger  of  the  disease  being  co 
municated  to  others. 

A. — Paraformaldehyde  and  Potassium  Perniangano' 
This  is  the  method  usually  employed  by  the  I 
partment    in    making    terminal    disinfection,    or   i 
disinfection  of  school  rooms.     Formaldehyde  disinC 
tion  is  most  efficient  if  the  temperature  is  above  GO 
and  the  atmosphere  not  too  dry.    When  the  air  of  1 
room  (as  in  many  steam-heated  buildings)  is  very  tf 
the  vent  cocks  of  radiators  may  be  opened  for  a  f? 
minutes  to  permit  the  escape  of  steam,  or  vessels  c< 
taining  steaming  water  may  be  placed  in  the  room 

1.  Ingredients  for  1,000  cubic  feet  of  air  space 

(a)  Paraformaldehyde — 30   grams    (7%    drams) 

(b)  Potassium     permanganate — 75     grams      (lit 
drams). 

(c)  Water   (hot  if  possible) — 90  c.c.   (3  ounces) 

2.  Procedure : 

(a)  The  rooms  to  be  disinfected  are  made  appro 
mately  airtight  by  sealing  with  gummed  paper  or  c 
ton,  all  doors,  windows,  chimney  flues  and  other  cr 
ices  and  openings. 

(b)  All  articles  in  the  rooms  are  freely  expos 
Bedding    and    clothing    are    placed    across    backs 
chairs,   or   on   clothes   lines.     Books   are   opened   n 
placed   on    end;    all    drawers    and   closet   doors    i 
opened. 

90 


I 


(c)  Secure  enough  vessels  or  dishes  (heavy  paper 
ejor  oil  cloth  will  answer),  one  for  every  1,000  cubic 
liijfeet  of  air  space  to  be  disinfected,  and  place  the  mlx- 
4iug  pans  in  them.  In  vacant  flats  such  vessels  can  be 
Dljobtaiued  from  a  neighbor.  Where  none  can  be  ob- 
ositained,  the  bath  tub,  sink,  etc.,  should  be  utilized  for 
jthe  purpose. 

8^     (d)   In  each  mixing  pan  is  placed  the  contents  of 
-one  carton  of  potassium  permanganate    (75  grams). 

(e)  90  c.c.  of  hot  water  (which  may  be  obtained 
[dfrom  neighbors  in  case  flat  is  vacant)  is  measured  in 
'jtbe  aluminum  cup  which  accompanies  each  outfit,  and 
t|poured  over  permanganate  crystals  which  are  allowed 

to  dissolve. 

(f )  When  all  the  pans  necessary  for  the  space  to  be 
disinfected  have  been  prepared,  the  contents  of  a  car- 

jton  of  paraformaldehyde  (30  grams)  is  poured  into 
;  each.  In  doing  this,  care  is  taken  to  add  the  first 
charge  of  paraformaldehyde  to  the  pan  furthest  from 
the  exit  of  the  room,  and  then  in  succession  to  the 
'others  in  the  order  of  distance  from  the  exit.  Before 
adding  paraformaldehyde  all  surplus  material  and 
equipment  are  removed  from  the  room,  and  the  occu- 
I'.iut  of  the  apartment,  if  there  be  one,  is  warned  to 
i« move  pet  animals  from  the  room. 

3.  The  minimum  length  of  time  necessary  for  effi- 
f'K^nt  disinfection  is  four  hours. 

4.  A  thorough  scrubbing  and  ventilation  of  the  flat 
iifler  disinfection  is  always  advised. 

B. — Liquid  Disinfectants  and  Uses. 

1.  For  all  body  discharges:  Freshly  made  chloride 
of  lime,  ij%  carbolic  acid  solution,  or  2%  lysol  solu- 
tion. 

91 


2.  For  bed  and  personal  linen :   Immersion  in  boi  I 
ing  water  for  five  minutes,  or  in  5%  carbolic  solutic 
for  one  hour,  the  articles  to  be  completely  submerge 

3.  For  washing  of  floors,  bedsteads  and  other  su 
faces:  Soap  and  hot  water  applied  with  scrubbii 
brush,  or  when  fouling  by  sputum  or  other  discharg( 
has  occurred,  the  saturation  of  deposited  matter  wit 
carbolic  solution  (5%)  or  lysol  solution  (2%)  an 
after  thirty  minutes  wiping  up  with  rags  or  other  a 
tides  that  can  be  boiled  or  burned. 

DISINFECTION  TESTS. 

Sec.  99.  When  disinfection  is  performed  and  good' 
are  to  be  removed  the  following  day,  a  test  envelop! 
(Form  78  J)  is  placed  in  the  room  to  be  fumigated  a!' 
least  six  feet  from  the  pan  containing  the  disinfectin! 
mixture ;  on  it  is  noted  the  family  name,  address,  did 
ease,  date  and  name  of  disinfector.  The  person  i! 
charge  is  notified  that  this  test  will  be  collected  by  th; 
driver  of  the  goods  wagon  and  must  not  be  destroyej 
or  thrown  away. 

DUTIES   OF   DISINFECTORS. 

Sec.  100.  Disinfectors  wear,  while  on  duty,  th( 
official  uniform,  which  must  be  kept  neat  and  clean 
They  must  carry  out  the  orders  of  the  district  diag 
nosticians  and  nurses  for  the  fumigation  of  infect*  < 
rooms  with  contents,  and  tie  up  in  proper  bundles  al 
goods  ordered  removed  for  sterilization  to  a  Depart 
ment  plant.  If,  for  any  reason,  a  disinfector  can  no 
fumigate  a  room  or  apartment  as  ordered,  he  imme 
diately  obtains  instructions  by  telephone  from  th( 
Borough  Office. 

92 


After  properly  sealing  the  outer  door,  the  official 

ojister   (115  J)    is  placed  upon  it,  showing  the  time 

Mimigation  began,  and  the  time   (not  less  than  four 

]i)urs  later)  when  room  can  be  opened  and  aired.    The 

jrson  in  charge  must,  without  fail,  be  notified  by  the 

sinfector  that  if  the  rooms  are  opened  before  the 

tjitiie  noted  on  the  paster  the  Department  will  refumi- 

ite. 

Disinfectors  report  at  the  Borough  Office  each  morn- 
g  (Sundays  and  holidays  excepted),  obtain  the  list 
cases  for  the  day,  make  out  and  leave  their  daily 
port  cards  (Form  169  J)  for  the  coming  day's  work 
id  sign  the  cards  for  the  day  before;  also  enter 
)ur  of  arrival  at  each  address,  obtain  a  proper  sup- 
y  of  paraformaldehyde,  potash,  gummed  paper,  tests, 
isters,  etc.,  and  leave  the  Borough  Office  not  later 
lan  8.30  A.  M.  (Time  of  arrival  and  departure  are 
amped  on  time  clock  card.) 

In  the  Borough  of  Queens,  the  cases  for  fumiga- 
?(|on  are  telephoned  to  the  disinfectors,  full  data  being 
ven,   and  the   disinfectors   mail   their   daily   report 
irds  to  the  Borough  Office. 

If  it  is  impossible,  for  any  reason,  to  perform  a 
lejmiigation  that  has  been  ordered,  the  facts  are  noted 
ai  the  daily  report  card  and  a  special  report  card 
gPorm  180  J).  Each  disinfector  ascertains  from  a 
!^)sted  list  in  the  Borough  Office  when  he  is  assigned 
lUr  night,  Sunday  or  holiday  duty,  and  is  ready,  when 

1  these  special  details,  at  all  times,  to  receive  notice 
)t»r  special  fumigations.  Each  morning  the  Disinfec- 
fr  »r-in-charge  at  each  Borough  Office  arranges  by 
lelstricts   the   "fumigation   cards"    (Forms   232   L,   94 

)   received  from  district  diagnosticians,  nurses  and 

93 


veterinarians,  eliecks  up  all  cases,  and  makes  out  lia 
for  each  disinfector. 

DUTIES  OF  DISINFECTOR-IN-CHARGE. 

Sec.  101.  Each  morning  the  Disinfector-in-chai 
at  headquarters  makes  out  a  list  (Form  9  J)  of  evf 
case  referred  that  morning  to  the  disinfectors  1 
fumigation,  showing  the  address  of  each  case,  a 
disinfector  to  whom  each  case  was  referred,  and 
list  (Form  31  J)  of  goods  to  be  removed  from  ea 
address  for  sterilization  or  destruction,  including 
cases  where  fumigation  has  not  been  performed, 
copy  of  this  list  is  sent  by  messenger,  during  the  di 
to  the  Disinfector-in-charge  of  the  Disinfecting  Pla 
and  from  it  he  makes  up  lists  for  the  goods  wag 
drivers  the  following  morning. 

A  list  is  also  sent  to  the  Research  Laboratory, 
messenger,  showing  the  addresses  from  which  tej 
are  to  be  returned,  and  the  names  of  disinfectors  ( 
rected  to  fumigate  the  premises  and  leave  the  tes 

A  list  showing  the  addresses  from  which  goods  a 
to  be  removed,  north  of  125th  Street,  Manhattan, 
also  sent  to  the  Disinfecting  Plant,  foot  of  East  132i 
Street,  Borough  of  the  Bronx,  and  from  this,  lists  f 
the  goods  wagon  drivers  of  that  Borough  are  ma 
up  the  following  morning. 

The  following  morning  at  8.30  A.  M.  the  Disinfectc 
in-charge  at  the  Borough  Office  cuts  from  the  list 
the  previous  morning,  each  address  where  fumigati< 
was  not  performed,  and  telephones  these  changes 
the  Disinfecting  Plant  and  to  the  Research  Labc 
atory. 

94 


DUTIES  OF  GOODS- WAGON  DRIVERS. 

Sec.  102.  Each  day,  goods-wagon  drivers  fill  out  in 
luplicate,  lists  (Form  26  N)  showing  addresses  from 
vhich  goods  have  been  removed  after  disinfection  and 
'umigation,  and  whether  or  not  a  test  was  brought 
:o  the  Disinfecting  Plant  from  each  address.  One 
;opy  of  these  lists  is  kept  in  the  Disinfecting  Plant 
ind  one  copy  is  delivered  to  the  Research  Laboratory 
vith  the  tests  that  have  been  collected. 

IMBULANCE  AND  WAGON  SERVICE  ;  STABLES ; 
DISINFECTING   PLANTS. 

Sec.  103.  Ambulance  and  wagon  service,  stables 
md  disinfecting  plants  are  under  the  direction  of  a 
Physician-in-charge,  who  reports  to  the  Chief  of  the 
Division  of  Contagious  Diseases.  He  submits  a  weekly 
•eport  of  the  work  performed  (Form  —  J)  ;  keeps  a 
»|iiary  of  current  events,  etc. 

AMBULANCE   SERVICE. 

Sec.  104.  There  is  maintained  in  each  Borough  an 
imbulance  service  for  removal  to  the  hospital  of  pa- 
rents suffering  from  infectious  disease. 

Manhattan:  Two  motor  and  three  horse-drawn  am- 
3ulances,  and  one  coupe. 

Brooklyn :  Two  motor  and  three  horse-drawn  ambu- 
lancea,  and  one  coupe.  (Patients  in  Borough  of 
Queens  are  also  removed  by  these  motor  ambulances.) 

Bronx:  One  motor  and  two  horse-drawn  ambu- 
lances, and  one  coup6. 

Richmond:  One  horse-drawn  ambulance  and  one 
2oup6. 

95 


Queens :  One  horse-drawn  ambulance. 

These  vehicles  are  kept  at  the  Department's  stable 
in  the  respective  Boroughs. 

The  motor  ambulance  service  is  superintended  b; 
a  Supervising  Automobile  Engineman,  who  report 
to  the  Physician-in-charge  of  the  service.  Requisition 
for  repairs  and  supplies  for  motor  vehicles  are  mad 
by  him  to  the  Physician-in-charge  of  the  service. 

Horse-drawn  ambulances  and  coulees  are  under  th 
charge  of  the  stable  foreman,  who  reports  to  the  Phy 
sician-in-charge,  and  who,  as  regards  motor  vehicles 
is  subject  to  the  orders  of  the  Supervising  Automobih 
Engineman. 

REMOVAL  OF  PATIENTS. 

Sec.  105.  Requisitions  for  removal  are  made  direcl 
by  the  Borough  Office  to  the  Borough  Stable.  (Re 
movals  from  institutions  on  islands  are  made  by  th« 
Department's  boat  service,  request  being  submitted  t( 
the  Superintendent  of  Hospitals.) 

In  emergency  cases  when  all  the  ambulances  of  on< 
stable  are  out,  requests  may  be  made  to  the  stable  oi 
another  Borough  to  send  motor  vehicle. 

Every  request  for  removal  is  entered  in  a  Borougl 
Stable  Journal  (Form  —  LL),  giving  date,  name,  ad 
dress,  disease  and  other  necessary  data. 

A  Service  Journal  (Form  —  LL)  is  also  kept  foi 
each  ambulance  or  other  vehicle,  in  which  is  recorded 
all  work  done.  This  book  is  kept  by  the  driver  or 
engineman  of  the  vehicle. 

96 


VEHICLE  SIGN. 

Sec.    106.     The   following   sign   Is    carried    on   the 

[ashboard  of  every  vehicle: 

SAFETY    FIRST. 

1.  In  case  of  doubt — stop. 

2.  Pedestrians  have  the  right  of  way. 

3.  Do  not  stop  your  vehicles  ou  cross-walks. 

4.  Observe  carefully   the  rules  of  the  road. 

5.  Never  leave  your  horse  untied  or  unguarded. 

6.  Give  courteous  and  direct  answers  to   all. 

7.  Do  not  injure  anyone. 

S.  Be  careful  of  all  Department  property  en- 
trusted to  your  care. 

9.     In  case  of  accident,  report  same  promptly, 

with  names  of  witnesses. 
10.     Be  alert,  careful ;  always  ready,  efficient. 
By  Ordee  of  the  Department  of  Health. 

DUTIES  OF  AMBULANCE  DRIVERS. 

Sec.  107.  Two  ambulance  drivers  are  on  duty  each 
alternate  twenty-four  hours,  and  a  fifth  driver  is  on 
duty  daily  from  10  A.  M.  to  G  P.  M.  Each  driver 
wears  an  official  uniform  when  on  duty  and  stamps 
on  his  time-clock  card  the  hour  of  reporting  for  duty, 
and  hour  when  tour  of  duty  is  ended.  Each  driver 
notes  in  his  Service  Journal  all  the  information  re- 
quired, concerning  each  ambulance  call  made  by  him. 
He  fills  out  and  signs  an  official  slip  (Form  10  J) 
which  accompanies  each  patient  to  the  hospital.  A 
special  slip  (Form  .37  .7)  is  forwarded  to  the  Borough 
Office  and  filed  in  case  envelope.    A  special  written  re- 

97 


port  is  forwarded  by  a  driver  if  any  accident  occurs  d 

while  on  an  ambulance  call.  While  out  on  call,  the- 
ambulance  driver  is  under  the  direct  orders  of  the 
accompanying  hospital  surgeon. 

STABLES. 
DUTIES  OF  FOREMAN  IN  CHARGE  OF  STABLE. 

Sec.  108.  The  Department's  stables  in  each  Bor- 
ough are  in  charge  of  a  foreman,  who  submits  a 
weekly  report  (Form  —  J)  of  the  work  performed, 
compiled  from  the  Stable  Journal.  He  reports  all  ab- 
sences, and  returns  to  duty  on  the  part  of  motormen, 
drivers,  stablemen,  etc.,  and  makes  requisitions  for  re- 
pairs and  necessary  material.  He  is  responsible  for 
the  keeping  of  the  Stable  Journal  and  for  the  Service 
Journals  for  each  vehicle.  He  maintains  in  each 
stable  a  bulletin  board  on  which  all  orders  are  posted, 
the  employees  concerned  signing  the  same.  He  super- 
vises daily  all  clock  cards  of  employees  and  certifies 
to  correctness  of  same  at  end  of  month.  He  has  super- 
vision over,  and  is  held  responsible  for  the  assign- 
ment of  work  to  the  various  employees  connected  with 
the  stable,  and  for  the  proper  care  and  maintenance 
of  live  stock,  vehicles,  appliances  and  materials  used 
in  and  about  the  stables  for  the  proper  carrying  out 
of  the  ambulance  and  goods  wagon  services.  He  or- 
ders through  the  Physician-in-charge  all  necessary 
supplies  for  horsedrawn  vehicles,  and  sees  that  all 
parts  of  the  stable,  disinfecting  chamber,  and  wagon 
shed  are  kept  clean  and  in  first-class  order.  He  sees 
that  all  records  are  properly  kept  and  that  each  am- 
bulance driver  and  stableman  performs  his  duty  in 
a  satisfactory  manner. 

98 


DUTIES  OF  STABLEMEN. 

Sec.  109.  Each  stableman  must  perform  faithfully 
le  duties  to  which  he  is  assigned  by  the  stable  fore- 

ui,  clean  and  care  for  the  horses,  clean  the  vehicles 
,  d  the  stables,  and  perform  such  duties  as  may  be 

signed  to  him.    He  must  stamp  on  a  time-clock  card 

e  hour  he  reports  for  duty  and  when  his  tour  of 

ity  is  ended. 

WAGON  SERVICE. 

Sec.  110.  There  are  maintained  in  each  Borough, 
otor  and  horse-drawn  trucks  for  the  removal  of  in- 
cted  articles  for  sterilization,  and  for  the  express 
rvice  of  the  Department  of  Health.  These  are 
ider  the  direction  of  the  foreman,  as  in  the  case  of 
mbulances. 

The  Supervising  Automobile  Engineman  is  respon- 
ble  for  the  proper  running  of  the  trucks,  and  for 

quisitions  for  motor  supplies. 

A  Service  Journal  is  kept  for  every  wagon  and 
[uck,  the  driver  of  same  being  responsible  therefor. 
!  These  motor-trucks,  goods-wagons  and  express 
agons  are  assigned  to  the  clerk  in  charge  of  the 
xpress  Service.     (See  Sec.  114.) 

DISINP^ECTION  PLANTS. 

Sec.  111.  Disinfection  Plants  are  maintained  in 
le  Boroughs  of  Manhattan,  Brooklyn  and  Richmond, 
ach  plant  is  in  charge  of  a  Disinfector,  who  super- 
ises  the  sterilization  of  all  goods,  who  reports  di- 
'ctly  to  the  Physician-in-charge  of  the  service.  He 
abmits  a  weekly  report  (Form  —  J). 

99 


DUTIES  OF  DISINFECTOR-IN-CHARGE. 

Sec.  112.  The  Disiufeetor-in-charge  at  the  plant  r 
ceives  each  day  from  the  Borough  Office  a  comple 
list  (Form  9  J)  of  all  goods  to  be  removed  the  fc 
lowiDg  day;  from  this,  a  list  (Form  29  J)  is  mac 
out  (according  to  districts)  for  each  goods  wage 
driver  who  is  to  collect  them.  On  each  list  is  note 
for  each  call  the  name,  address,  floor,  disease,  and 
list  of  all  articles  to  be  removed. 

He  enters  in  a  book  provided  for  the  purpose  (For; 
18  JJ)  a  complete  list  of  all  goods  collected  each  da: 
by  each  goods-wagon  driver,  and  also  enters  in  ai 
other  book  (Form  —  J)  a  complete  list  of  all  gooc 
delivered  each  day,  by  each  goods  wagon  driver. 

He  sends  to  the  Borough  Office  each  day  a  coj 
(Form  28  J)  of  the  list  (Form  9  J)  received  tl 
previous  day,  on  which  is  noted  for  each  lot  of  gooc 
to  be  collected,  "collected  as  per  list,"  "family  out 
"goods  refused,"  etc.  He  also  sends  to  the  Boroug 
Office  each  day,  for  filing  in  case  envelope,  all  receipt 
for  goods  collected,  sterilized  and  returned,  and  fc 
goods  destroyed.  He  sends  each  day  to  the  laboratoi 
all  tests  collected  by  the  drivers.  He  sends  to  tt 
Borough  Office  a  daily  report  (Form  —  J)  (on  a  blan 
provided  for  the  same)  of  the  work  performed  at  th 
station.  He  supervises  the  proper  fumigation  an 
sterilization  of  all  goods  and  books  brought  to  tt 
station,  the  destruction  of  goods  in  the  furnace,  whe 
so  ordered,  and  the  return  of  goods  after  sterilize 
tion.  He  is  responsible  for  the  work  of  the  goo(3 
wagon  drivers  and  the  helpers  at  the  station.  H 
makes  requisitions  for  necessary  supplies  through  th 
Physician-in-charge. 

100 


The  Disinfector-in-charge  at  the  Borough  Office 
eeps  a  record  of  the  work  performed  weekly  by  each 
isinfector  (Form  170  J). 

RULES    FOR    DRIVERS    OF    GOODS-WAGONS. 

Sec.  113.  Drivers  must  wear,  while  on  duty,  the 
fflcial  uniform,  which  must  be  kept  neat  and  clean. 

Every  morning  the  Disinfector-in-charge  at  the  Bor- 
agh  plant  furnishes  each  driver  who  collects  goods, 
^ith  a  list  (Form  30  J)  on  which  is  noted  for  each 
lace  at  which  he  is  to  call,  the  name,  address,  floor, 
isease,  and  list  of  articles  to  be  removed.  The  driver 
lakes  sure  fumigation  has  been  performed  before  re- 
loving  goods.  The  driver  removes  onli/  goods  called 
or  on  his  list.  He  also  collects  and  places  in  an  en- 
elope  provided  for  the  purpose  (Form  149  J)  all  tests 
;ft  in  the  rooms  fumigated  by  the  disinfectors.  Each 
river  leaves  with  the  family  an  official  receipt  (Form 

J  J)  properly  dated,  filled  out  and  signed,  for  aW 
rticles  that  are  to  be  sterilized  and  returned.  For 
11  articles  that  are  destroyed,  he  has  a  member  of 
iie  family  sign  a  special  official  order  (Form  4  JJ). 
hould  the  family  request  the  destruction  of  goods  not 
n  his  list,  the  driver  may  comply,  but  obtains  a 
roperly  signed  order  and  reports  the  facts  to  the 
Hsinfector-in-charge.  Should  the  family  request  the 
emoval,  for  sterilization,  of  goods  not  on  the  list, 
lie  driver  obtains  permission  by  telephone  from  the 
forough   Office   before  complying. 

Drivers  who  deliver  the  goods  that  have  been 
terilized  obtain  the  receipts  left  the  day  previous, 
laking  sure  they  are  properly  dated  and  signed. 
foods  are  not  delivered  unless  a  proper  receipt  is 
htained. 

101 


Drivers  call  at  the  branch  libraries  in  their  districts 
several  times  each  week,  and  collect  all  books  returnee 
from  families  where  measles  has  occurred.  These  arc 
returned  the  following  day,  after  having  been  fumi 
gated  or  sterilized. 

They  also  call  at  houses  to  collect  library  book; 
from  families  where  scarlet  fever  or  diphtheria  ha; 
occurred.  They  are  delivered  to  the  Department  Hos 
pitals. 

All  receipts  for  goods  sterilized  and  for  goods  de 
stroyed  are  given  to  the  Disinfector-in-charge  of  dis 
infection  plant,  and  the  carbon  copies  kept  in  th( 
drivers'   receipt  books    (Form  13  EE)    as  vouchers. 

All  drivers  will  be  held  responsible  for  goods  whil( 
in  their  care.  Each  driver  enters  his  day's  work  ii 
the  Service  Journal  of  his  wagon  or  truck  and  stamp: 
the  time  of  arrival  and  departure  from  the  plant,  oi 
his  time-clock  card. 

EXPRESS   SERVICE   OF  THE   DEPARTMENT  01 

HEALTH. 

See.  114.  The  Express  Service  of  the  Departmen 
of  Health  delivers  supplies  to  milk  stations,  clinics 
camps,  culture  stations,  hospitals  and  laboratories 
delivers  mail  at  Headquarters ;  collects  water  samples 
infected  books  from  libraries  for  sterilization,  and  in 
fected  bedding  and  clothing  from  cases  of  infectioui 
diseases  requiring  such  removal.  Rabid  dogs  are  re 
moved  by  this  service. 

Motor  trucks,  goods-wagons  and  express  wagon  serv 
ice  are  assigned  to  the  Clerk-in-charge  of  supplies. 


102 


J 


The  City  is  divided  into  eleven  territories,  and 
ese  are  subdivided  into  districts.  A  wagon  is  as- 
£?ned  to  each  territory,  and  is  required  to  cover  one 
strict  of  a  territory  daily. 

All  applications  for  service  are  made  on  request 
rds  (Form  —  L)  and  forwarded  the  day  before  the 
iviee  is  required  to  the  Clerk-in-charge  of  supplies 
the  Executive  Office,  Bureau  of  Infectious  Diseases. 
le  Clerk-in-charge  of  supplies  maintains  a  book  in 
hich  are  entered  all  requests  for  service,  the  boundar- 
■:  of  territories  and  districts,  and  the  wagons  there 
signed. 

Each  driver  is  required  to  forward  to  the  Executive 

ifice  a  written  daily  report  of  the  work  performed, 
■livers  are  furnished  with  receipt  books  (Form  13  EE) 
.'d  will  secure  signatures  for  all  deliveries. 

All  requests  for  the  collection  of  infected  goods  must 
I  telephoned  by  the  Borough  Office  to  the  Clerk-in- 
large  of  supplies  in  the  Executive  Office,  before  4 
•1  M.  of  the  day  preceding  the  desired  service.  In 
(lorgency  cases  as  in  small-pox,  cholera,  etc.,  the 
tier  for  collection  is  sent  direct  to  the  foreman  of 
:t3  stable  by  the  Borough  Office. 

Automobile  trucks  are  used  to  cover  outlying  Bor- 
cghs. 

Motorcycles  are  used  for  the  daily  delivery  of  Pas- 
t  IF    treatments. 

^Vagons  of  tliis  service  are  used  in  the  various  Bor- 
s  for  the  collection  of  rabid  dogs  and  for  the  dis- 
lion    of    stables    following    the    appearance    of 

lers. 

103 


DIVISION  OF  INSTITUTION  INSPECTION. 
FUNCTIONS. 

Sec.  115.  1.  Enforcement  of  regulations  of  the  Di 
partment  of  Health  regarding  infectious  diseases  1 
hospitals,  dispensaries,  day  nurseries,  camps,  home 
for  the  aged  and  crippled,  homes  for  working  girls  an 
children's  institutions  and  asylums. 

2.  The  periodical  reinspection  of  these  institution 

3.  Diagnosis  and  removal  (if  necessary)  of  cases  ( 
infectious  diseases  in  institutions. 

4.  Supervision  and  termination  of  quarantine  i 
institutions. 

.5.  Obtaining  the  reports  of  cases  of  venereal  dis 
eases  in  institutions. 

6.  Examination  for  infectious  diseases  of  prisoner 
in  City  prisons. 

7.  Supervision  of  whooping  cough  clinics  (see  Se< 
89). 

REGULATIONS     FOR     THE     MANAGEMENT     01 

CASES  OF  INFECTIOUS  DISEASES  IN 

INSTITUTIONS. 

Sec.  IIG.     Preliminary  examination  by  a  physicia 

if  possible,  of  all  new  applicants — especially  of  chil 

dren — for  contagious  diseases,  is  to  be  made  on  thei 

entering  the  hospital   or   institution   before   allowin 

them  to  mingle  with  other  patients  in  a  common  wait 

ing  room  or  elsewhere.     The  Department  of  Healtl 

urges   that  cultures  be  taken  in  every  case  in  ao, 

way   suggesting    diphtheria    and    that    anti-toxin    b 

freely  used  without  waiting  for  the  result  of  the  cul 

ture.     The  Department   of   Health  will,   on   request 

supply  all  institutions  free  of  charge  with  diphtheri) 

101 


id  tetanus  antitoxin,  small-pox  and  typhoid  vaccine, 
Qd  outfits  for  forwarding  specimens  for  examination 
>  the  Diagnosis  and  Serological  Laboratories  (cul- 
ire  tubes,  sputum  jars,  typhoid  blood  and  urine, 
lalaria  and  Wassermann  outfits). 

ISOLATION. 

Sec.  117.  Sanatorium,  sanitarium,  day  nursery,  con- 
ilescent  home  for  children,  reformatory,  training 
hool,  boarding  school,  hospital,  dispensary  or  insti- 
ition  for  the  care  or  treatment  of  persons  must 
rovide  and  maintain  a  suitable  room  or  rooms  for 
le  temporary  isolation  of  persons  suffering  from 
ifectious  diseases.  Cases  of  small-pox  or  those  sus- 
cted  of  having  this  disease,  and  chicken-pox  in 
iults  must  be  held  in  isolation  until  seen  by  an  in- 
)ector  of  the  Department  of  Health,  and,  if  necessary, 
le  assistance  of  the  police  will  be  obtained  to  en- 
)rce  this  detention. 

Cases  of  diphtheria,  scarlet  fever  and  measles  must 
jmain  in  the  isolation  room  until  seen  by  an  inspec- 
)r  of  the  Department  of  Health  unless  they  reside 
»  near  the  institution  as  to  be  able  to  return  home 
ithout  using  public  conveyances,  and  desire  to  do 
>.  Such  cases  must  have  a  private  physician.  Cases 
'  minor  contagious  diseases,  such  as  chicken-pox  in 
aildren,  mumps,  whooping  cough  and  German  measles 
lould  not  be  admitted  to  the  institution,  but  should 
e  sent  to  their  homes  promptly. 

REMOVALS  TO  HOSPITALS. 

Sec.  118.  Every  case  of  small-pox  will  be  removed 
y   a    Department  of   Health    ambulance.     Cases   of 

105 


diphtheria,  scarlet  fever  and  measles  will  be  removi 
by  the  Department  of  Health  whenever  necessary, 
condition  of  patient  warrants.  The  representative  ( 
the  institution  will  caution  patients  ill  of  infectioi 
diseases  against  the  use  of  public  conveyances  ai 
visiting  places  of  public  assembly. 

QUARANTINE. 
Sec.    119.     (a)   Hospitals:     Wards    in    which    coi 
tagious  diseases  develop  will  be  quarantined  by  tt 
Department  of  Health  as  follows: 

Diphtheria— Quarantine  is  not  required  if  all  pi 
tients  present  or  admitted  are  immunized  and  cu 
tures  do  not  show  diphtheria  bacilli;  otherwise  fiv 
days. 

Scarlet  Fever— Five  daj'-s  (children's  wards  onl: 
except  where  several  cases  occur  in  an  adult  ward). 

Measles— Fourteen  days  (children's  wards  only,  es 
cept  where  several  cases  occur  in  an  adult  ward). 

Small-pox — ^Twenty-one  days,  with  the  exception  o 
those  exposed  to  small-pox:  adult  patients  in  quarar 
tine  wards  desiring  to  return  to  their  homes  may  d< 
so  if  their  names  and  home  addresses  are  forwarder 
to  the  Department  of  Health. 

(b)  Institutions:  Dormitories  or  parts  of  buildini 
in  which  contagious  diseases  develop  will  be  quaran 
tined  as  follows : 

Diphtheria— Five  days  (children's  dormitory  only 
except  where  several  cases  develop  in  an  adult  dormi' 
tory). 

Scarlet  Fever— Five  days  (children's  dormitorj 
only,  except  where  several  cases  develop  in  an  aduH 
dormitory). 

106 


Measles — Fourteen  days  (children's  dormitory 
(Illy,  except  where  several  cases  develop  in  an  adult 
:lormitory) . 

Small-pox — Twenty-one  days. 

Whenever  contagious  disease  develops  in  more  than 
lone  dormitory  at  the  same  time,  the  entire  institu- 
tion may  be  quarantined. 

[Note. — No  cases  may  be  admitted  to  or  discharged 
from  quarantined  dormitory,  or  entire  institution  if 
quarantined,  until  quarantine  is  terminated  by  the 
Departiuent  of  Health.  Children  attending  school 
will  be  excluded  during  the  incubation  period  of  the 
disease  in  question.] 

(c)  When  nurseries  and  day  camps  are  quarantined 
no  new  cases  may  be  admitted  until  quarantine  is 
terminated  by  the  Department  of  Health. 

CHIEF  OF  DIVISION. 

Sec.  120.  The  Chief  of  Division  exercises  general 
supervision  over  all  matters  pertaining  to  the  work 
of  his  division  throughout  the  city.     (See  Sec.  49.) 

OFFICE  OF  THE  CHIEF  OF  DIVISION. 

SUPERVISION  OF  INSTITUTIONS. 

Sec.  121.  Every  institution  is  supplied  with  a  plac- 
ard (hospitals  Form  249  L,  dispensaries  Form 
2-2~>  L),  to  be  posted,  giving  regulations  regarding 
iiiMnngement  of  infectious  diseases.  A  history  card 
(I'orni  —  L)  is  kept  for  each  institution,  giving  full 
iiifonnution,  the  name  and  address  of  the  institution, 
fh.iractcr  und  ca])acity,  names  of  officials  and  facil- 
ii  i*'S  for  isolation.     Every   institution  is  revisited  at 

107 


least  once  a  year.  A  "subsequent  visit"  card  fi] 
(Form  —  L)  is  kept,  giving  date  of  next  visit  b 
inspector  and  results  of  inspection.  This  card  3 
forwarded  to  the  inspector  when  visit  is  due  an 
returned  by  him  with  proper  entries  after  each  visil 
From  time  to  time,  surveys  are  made  regardin 
particular  subjects  (isolation  facilities,  etc.)  ;  th 
location  and  character  of  institutions  are  indicated  oi 
large  compo  maps  by  vari-colored  pins.  Whenever  a] 
institution  is  quarantined  because  of  infectious  dis 
ease,  notices  are  sent  to  the  institution,  to  the  Stat 
Board  of  Charities,  to  the  Department  of  Education 
to  the  Society  for  the  Prevention  of  Cruelty  to  Chil 
dren  and  to  the  Borough  Chief  where  the  institution  ii 
located.  A  weekly  report  by  Boroughs  is  submittec 
(Form  222  L),  giving  the  number  of  infectious  disease! 
pending  in  and  removed  from  each  institution,  anc 
the  average  daily  time  and  number  of  visits  of  eact 
inspector. 

NOTIFICATION. 

Sec.  122.  Every  institution  is  supplied  with  ai 
Infectious  Disease  Journal  (Form  9  LL),  into  which 
is  copied  from  a  blank  (Form  280  L)  every  case  of 
infectious  disease  occurring  in  the  institution.  This 
journal  is  divided  into  three  sections,  for:  (a)  Con- 
tagious diseases;  cases  of  contagious  diseases  are 
immediately  reported  to  the  Borough  Office  by  tele- 
phone and  also  by  postal,  (b)  Tuberculosis;  the  De- 
partment of  Health  obtains  reports  of  cases  of  Tuber- 
culosis by  telephone  at  regular  intervals,  (c)  Venereal 
diseases;  the  inspectors  of  the  Division  of  Institu- 
tion Inspection  call  regularly  and  copy  off  the  reports 
of  cases  of  Venereal  Diseases. 

108 


REGISTRATION. 

Sec.  123.  In  the  Borough  Olfice  an  envelope  (Form 
)  J)  is  made  out  for  each  institution  case  and  filed 

the  current  envelope  case  file.  Cases  are  also  re- 
>rted  by  the  Borough  Office  to  the  proper  Branch 
ffice  on  the  daily  report.  At  the  Branch  Office  a 
eleton  history  card  is  made  out  and  filed  in  the 
;tive  name  file  of  the  Branch  Office.  All  such  eases 
•e  included  in  the  weekly  report  of  the  Branch 
Efice,  but  are  not  visited.  The  Borough  Office  noti- 
's  the  Branch  Office  of  the  discontinuance  of  the 
SB  and  skeleton  history  card  above  referred  to  is 
.'stroyed. 
A  list  of  all  cases  of  infectious  diseases  reported 

forwarded  by  the  Borough  Office  to  the  Division  of 
stitution  Inspection. 

OFFICE  OF  DIVISION  OF  INSTITUTION  IN- 
SPECTION. 

Sec.  124.  A  day  book  is  kept  of  all  cases  of  infec- 
1>us  diseases  occurring  in  institutions,  name  of  dis- 
"■'f,   date   reported,   disposition,  and  date  of   termi- 

liou  of  each  case,  being  recorded. 

A  house  card  (Form  95  L)  is  kept  for  each  in- 
iiition  giving  the  above  information  concerning 
1  y  case  of  infectious  disease  reported.    On  removal 

<  termination  of  cases  remaining  in  institutions  the 
"etor's  history  card   (Form  20  J)    is  returned  by 

•  li  to  the  Office  of  the  Division  of  Institution  Inspec- 

f  n  where  facts  are  entered  in  the  day  book  and  on 

itistitution   house  card;   the  history   is   then   for- 

M.led   to    the    Borough    Office    to   be   placed   in   an 

'  velope  in  the  terminated  case  file. 

109 


ASSIGNMENT  OF  CASES. 
Sec.  125.  [Note. — Ou  account  of  the  long  distant 
involved  in  the  Boroughs  of  Queens  and  Richmoi, 
the  district  diagnosticians  of  those  Boroughs  respcl 
to  calls  from  institutions,  making  diagnoses  and  ord- 
ing  removal  of  cases  to  the  Health  Department  Hj- 
pitals.  Cases  of  infectious  diseases  remaining  in  ■ 
institutions  of  the  said  Boroughs  are  visited  and  I 
lowed  up  in  the  usual  way  by  institution  inspector] 

The  City  is  divided  into  districts,  to  each  of  whi 
is  assigned  an  institution  inspector.  Every  insti.- 
tion  case  reported  to  the  Borough  Office  is  at  oi? 
assigned  by  telephone  to  the  proper  inspector, 
details  of  the  case,  and  later  the  inspector's  rept 
being  entered  on  assignment  slip  (Form  125  J),  whi 
is  forwarded  to  the  Borough  Office,  thence  to  e 
Office  of  the  Division  of  Institution  Inspection  £l 
finally  returned  to  the  Borough  Ofiice  to  be  filed  in  e 
envelope  of  the  case.  In  addition  to  subsequent  v  t 
cards  mentioned  above,  typhoid  fever,  epidemic  c( 
bro-spinal  meningitis  and  poliomyelitis  histories,  t 
of  pending  cases  of  diphtheria,  scarlet  fever  il 
measles  due  for  inspection  and  discharge,  and  reque  a 
for  special  investigation  (Form  178  J)  are  forward! 
to  inspectors  from  the  Division  Office. 

DUTIES    OF    INSTITUTION    INSPECTORS. 

Sec.  126.  When  a  case  is  assigned  to  an  inspecr 
of  the  Division  of  Institution  Inspection,  he  at  oe 
makes  out  a  history  (Form  20  J).  He  holds  this  1'- 
tory,  entering  the  results  of  all  subsequent  visits  n 
the  reverse  of  the  card.  When  case  is  terminated  y 
recovery,  death  or  removal,  the  card  is  forwardedo 
the  Office  of   the  Division  of  Institution  Inspect]  i, 


110 


11 


nd  thence  to  the  proper  Borough  Office  where  the 
History  is  filed  in  the  envelope  of  the  discontinued 
lase  file  for  the  particular  disease.  In  cases  for  re- 
fiioval,  the  inspector  makes  out  a  removal  slip  (Form 
fO  J).  He  informs  the  authorities  of  the  institution 
if  the  destination  of  the  case  together  with  the  ad- 
iress  and  telephone  number  of  the  hospital.  After 
case  of  infectious  disease  is  removed  from  a  hos- 
ital  or  institution  the  inspector  for  that  institu- 
ion  is  notified :  he  visits  the  institution  at  regular 
atervals  and  examines  all  persons  exposed  to  the 
articular  disease.  If  any  new  cases  are  found,  he 
lOtifies  the  Borough  Office  by  telephone,  stating 
/hether  or  not  the  case  is  to  be  removed  to  the  hos- 
iital,  the  authorities  reporting  the  case  to  the  De- 
lartment  by  postal  card  in  the  usual  way.  If  a  case 
emains  at  an  institution,  it  is  the  duty  of  the  in- 
pector  to  see  that  proper  isolation  is  provided  and 
laiutained.  Frequent  visits  are  made  to  examine  all 
persons  exposed  and  also  to  see  that  adequate  quaran- 
,ine  facilities  are  provided.  When  the  time  prescribed 
,y  the  Department  of  Health  for  the  disease  expires, 
jie  patient  is  inspected  and  officially  discharged  if 
■•ee  from  contagion.  After  the  discharge  of  the  last 
ise,  the  quarantine  is  ended  at  the  termination  of 
le  incubation  period  of  the  disease  in  question,  if 
0  new  cases  have  developed.  The  development  of 
Rrery  new  case  requarantines  the  institution  from 
lie  date  of  the  last  onset  of  the  disease.  Children 
ittendlng  public  schools  are  excluded  during  the  quar- 
•ntlne  period.  The  inspectors  are  held  responsible  for 
ue  accuracies  of  their  diagnoses  and  at  any  time  when 
(  Physlcian-in-charge  of  a  Health  Department  Hos- 
iital  questions  or  is  dissatisfied  with   the  diagnosis 

111 


of  the  case,  they  must,  if  requested,  go  to  the  I 
partmeiit  Hospital  and  verify  or  change  the  origii 
diagnosis.     In  all  cases  where  the  clinical  symptoi 
are  so  exceptional  that  a  positive  diagnosis  cannot 
made,  they  are  to  see  that  the  best  possible  arrant 
ments  are  made  for  the  isolation  of  such  cases.    TL 
are  to  examine  the  case  again  on  the  following  di. 
and  then  if  they  are  not  satisfied  as  to  the  diagnos, 
the  case  may  be  referred  to  the  Borough   Diagn( 
tician  for  his  decision. 

In    making   their    diagnoses,    institution    inspect^ 
must  at  all  times  respect  the  opinions  of  the  visit! 
physicians   in   the   various   hospitals   and  institutic; 
and  work  in  harmony  with  them  as  far  as  possib. 
Inspectors   should  maintain  the  friendliest  relatio? 
with  the  authorities  of  the  various  institutions  al 
keep   them    informed    as    to    the    regulations   of   t' 
Department  of  Health,  and  do  all  they  can  to  ass 
in  eliminating  any  contagious  diseases  that  may  occ  , 
In   every   new   case   of   scarlet   fever,    diphtheria   • 
measles  found  in  an  institution,  they  must  at  once  - 
port  to  the  Borough  Office  by  telephone  and  later  ' 
postal  card,   the  name,  address,  age  of  patient,  al 
date  of  report  of  diagnosis.     They  must  make  outi 
history  card  (Form  20  J)  for  every  case  seen  and  n(? 
all  subsequent  visits  with  result3  on  the  reverse 
the  card.     The  inspectors  will  administer  diphthei 
antitoxin  when  requested  by  the  authorities.     In   i 
eases  of  diphtheria,  the  immunization  of  persons  ( 
posed  is  done  by  the  inspectors  and  final  cultures  ; 
taken  by  them. 


Inspectors  are  responsible  for  the  notification  a  I 
registration  of  Typhoid  Fever,  Cerebro-Spinal  Men*- 

112 


Itis,  Acute  Poliomyelitis  and  Venereal  Diseases  in 
istitutions.  Whenever  an  inspector  finds  in  any 
istitution  an  unreported  case  of  Typhoid  Fever, 
'erebro-Spinal  Meningitis  or  Acute  Poliomyelitis,  he 
lis  out  a  special  report  card  (Form  18  J),  giving 
ame  of  institution  and  disease,  name,  age  and  home 
ddress  of  the  patient.  Inspectors  visit  institutions 
/here  records  of  cases  of  venereal  disease  are  kept. 
'rom  these  records  they  fill  out  a  card  (Form  191  L) 
or  each  case,  giving  disease,  name,  age  and  home 
ddress  of  the  patient.  These  last  two  cards  (Forms 
8  J  and  191  L)  are  forwarded  by  inspectors  to  the 
ffice  of  the  Division  of  Institution  of  Inspection, 
nspectors  make  sure  that  the  oflicial  placard  of  the 
)epartment  of  Health  is  posted  in  every  Institution 
nd  that  each  one  is  supplied  with  and  maintains  an 
nfectious  Disease  Journal.  They  also  make  sure  that 
pecial  communications  to  institutions  are  posted. 

DIVISION  OF  TUBERCULOSIS. 

Sec.  127.  The  Division  of  Tuberculosis  is  charged 
vith  the  registration  and  sanitary  supervision  of  all 
■ases  of  pulmonary  tuberculosis  occurring  in  New 
fork  City. 

ORGANIZATION. 

Sec.  128.  (a)  The  Chief  of  Division  exercises  gen- 
eral supervision  over  all  matters  pertaining  to  the 
vork  of  his  Division  throughout  the  city.  He  is 
issisted  by  a  Supervisor  of  Clinics. 

(b)  Borough  Offices. —  (See  Directory,  Sec.  2,  also 
5ecs.  37  to  43.) 

(c)  Branch  Offices. —  (See  Directory,  Sec.  2,  also 
>ecs.  37  to  43.) 

113 


(d)  Clinics  and  Clinic  Districts. — Each  Borough  if 
divided  into  one  or  more  tuberculosis  clinic  districts 
in  each  of  which  is  a  tuberculosis  clinic,  with  its  stafl 
of  physicians  and  nurses.  For  location,  hours  ant 
boundaries  of  districts,  see  Directory  and  Maps,  Sec 
2.  Each  clinic  cares  for  all  patients  from  its  owi 
district.  In  Manhattan  a  number  of  other  clinics 
are  maintained  by  the  large  general  hospitals,  aiu 
do  their  own  district  visiting.  All  of  the  tuberculosis 
clinics  are  united  into  an  Association  of  Tuberculosis 
Clinics.     (See  Sec.  237.) 

(e)  Clinic  Auxiliaries. — Associations  for  rendering 
necessary  charitable  aid  to  patients  of  the  Tubercu- 
losis Clinics. 

(f)  Local  Cli7iic  Relief  Committees. — Composed  of 
the  Physicians-in-charge,  and  representatives  of  the 
Auxiliaries  and  of  the  various  charitable  organiza- 
tions. 

(g)  Tuhcrculosis  Hospital  Admission  Bureau,  42G 
First  Avenue,  Manhattan. — For  admission  of  all  cases 
of  pulmonary  tuberculosis  to  hospitals,  sanatoria,  and 
preventoria  for  Children,  Maintained  jointly  by  the 
Department  of  Charities,  the  Department  of  Health, 
and  Bellevue  and  Allied  Hospitals. 

(h)  Tuberculosis  Day  Camps. — For  care  of  suitable 
cases  living  at  home.  Manhattan,  foot  of  East  91st 
Street.    Brooklyn,  foot  of  Fulton  Street. 

NOTIFICATION    AND    REGISTRATION. 

Sec.  129.  These  are  described  under  Infectious 
Diseases.  (Sec.  38.)  Every  case  reported  is  acknowl- 
edged by  card  (Form  16  L). 

114 


PROCEDURE    AT    BRANCH    OFFICES. 

3ec.  130.  At  each  Branch  OflSce  are  filed  the  en- 
opes  and  case  records  of  all  cases  of  tuberculosis 
ing  as  the  last  address,  one  in  the  district.  When 
les  leave  the  districts,  their  records  are  trans- 
red  to  a  central  borough  file,  a  transfer  card 
orm  SOL)  being  kept  in  the  old  file  until  word  is 
i  of  their  receipt  at  the  new  Branch  Office, 
rhe  Borough  Office  forwards  to  the  proper  branch 
ce  a  tracer  (Form  266  L)  in  order  to  verify  the 
V  address.  If  the  case  is  located  the  records  are 
warded,  a  record  being  kept  on  a  tally  card  (Form 
t  L).  If  not  found  they  are  retained  in  the  central 
rough  file  until  the  case  is  again  located,  a  tally 
'd  (Form  263  L)  being  forwarded  to  the  Branch 
ice  of  the  district  of  last  address,  notifying  it  of 
;  facts. 

^t  each  Branch  Office  the  records  are  divided  into 
many  subsections  as  there  are  nurses'  districts 
the  district.  Thus  each  nurse  has  her  own  cur- 
it  record  and  house  file.  The  system  of  regis- 
tion  is  as  follows: 

CURRENT    RECORD    FILE. 

5ec.  131.  The  cards  in  these  files  are  divided  into 
)  six  recognized  classes  of  cases — and  are  shifted 
>m  one  class  to  another  aa  occasion  arises.  (See 
er.)  Each  case  has  its  record  envelope  (Form 
)  L)  on  which  are  entered:  (1)  the  name,  age, 
8t  address,  sex,  marital  state,  occupation,  nationality, 
te  of  first  report,  first  positive  sputum  examination 
any,  annual  record  number  and  Borough,  and  by 
lom  the  case  was  first  reported ;  (2)  all  subsequent 

115 


changes  of  class,  of  address,  or  of  attending  phys 
cian.  The  dead  cases  are  removed  as  they  occi 
and  forwarded  to  the  Borough  Office.  Gases  n( 
found  at  the  address  given  and  no  subsequent  repoi 
of  which  is  received  in  one  year,  cases  that  have  lei 
the  city  permanently,  and  recovered  and  non-tube 
culous  cases  are  filed  in  a  "discontinued"  file. 

In  the  record  envelope  are  filed  the  history  care 
(Form  44  L)  giving  the  information  obtained  by  tl 
nurses  and  inspectors  of  the  Department  of  Health  ; 
to  (a)  the  house;  (b)  the  home,  or  rooms  occupied  t 
the  patient  or  his  family;  (c)  the  family;  (d)  the  ec 
nomic  conditions;  and  (e)  the  patient — ^physical  coi 
dition,  precautions  observed,  treatment,  etc.  All  lat( 
records  of  every  kind  (reports,  nurses'  visits,  disinfe 
tions,  admissions  to  hospitals,  etc.)  are  entered,  wit 
dates,  on  a  later  history  card  (Form  267  L).  Tl 
history  cards  of  cases  under  close  sanitary  supe 
vision  by  nurses  are  not  filed,  but  are  kept  separal 
in  the  files  for  periodical  review  by  the  Physician-ii 
charge,  who  is  expected  to  confer  with  each  distri 
nurse  attached  to  the  Branch  Office  under  his  charg 
at  least  once  a  week  regarding  the  cases  of  tube 
culosis  under  close  supervision.  Each  nurse  shou] 
be  assigned  a  stated  day  and  hour  for  confereiM 
each  week. 

GENERAL   ROUTINE. 

Sec.  132.  On  receipt  of  report  of  a  case,  from  wha 
ever  source,  it  is  searched  for  in  the  record  ai 
house  files;  if  found  to  have  been  previously  r 
ported,  the  facts  given  in  the  report  are  entered  c 
the  record  envelope  and  also  on  the  house  card,  if  ne 
essary.  If  not  in  the  record  file,  it  may  be  found  : 
the  house  index,  where  it  may  be  under  a  diflferei 

116 


J  differently  spelled  name.  An  envelope,  primary  his- 
'y,  and  later  history  card,  and  (if  a  new  house) 
house  card  are  made  out  for  every  new  case.  The 
use  card  is  filed.  With  the  exception  of  those 
ses  reported  by  private  physicians  and  by  non- 
(partment  of  Health  tuberculosis  clinics  In  Man- 
ttan,  all  cases,  whether  new  or  old,  are  then  as- 
;ned  to  nurses  to  visit  (1)  to  obtain  a  history  and 
ep  under  supervision  or  observation;  (2)  to  order 
5  necessary  disinfection,  or  (3)  to  investigate  com- 
lints.  The  record  envelope  remains  in  the  current 
?,  and  the  primary  and  later  history  cards  are  given 
t  to  the  nurse,  to  be  returned  the  following  day. 
1  records  of  revisits  are  entered  on  the  later  his- 
ry  card.  A  numerical  daily  tally  is  kept  of  the 
mber  of  cards  given  to  and  returned  by  each  nurse. 

MONTHLY    CENSUS. 

Sec,  133.  On  the  last  Friday  of  every  month  each 
strict  nurse  counts  the  number  of  envelopes  in  each 

the  six  classes  of  her  file,  corrects  mistakes  in  filing, 
moves  duplicates,  etc.,  a  record  being  kept  in  the 
anch  Office.  The  figures  are  also  sent  to  the  clinics 
:  use  in  their  monthly  report  to  the  Association 

Tuberculosis  Clinics. 

LILY     REPORT     TO     HOSPITAL     ADMISSION 
BUREAU. 

Sec.  134.  All  changes  of  address,  departure  from 
J  city,  etc.,  of  cases  that  have  ever  been  in  a  tuber- 
losis  hospital,  are  reported  daily  (Form  153  L)  to 
i  Hospital  Admission  Bureau. 

117 


CLASSIFICATION  OF  OASES. 

Sec.  135.  The  procedure  varies  somewhat  with  t 
character  of  the  case.  The  cases  in  the  current  i 
are  grouped  in  six  classes  as  follows:  (1)  Unc 
care  of  private  physicians.  (2)  Under  care  of  n< 
Department  clinics  doing  their  own  nursing.  ( 
Cases  in  hospital.  (4)  Cases  in  sanatoria  and  ( 
of  town  temporarily.  (5)  Cases  not  found  at  addr( 
given.  (6)  Cases  at  home,  and  not  under  a  phj 
clan's  care. 

CLASS  I.  CASES  UNDER  THE  CARE  OF  PRIVA'. 
PHYSICIANS. 

Sec.  136.  These  cases  are  given  to  the  nurse  1 
"information  only,"  and  the  locality  visited  to  asc 
tain  if  there  is  a  house  at  the  address  given,  and 
character:  i.  e,  private  one-family  house,  teneme 
etc.  Further  information  regarding  these  cases 
obtained  from  the  physician  on  a  special  card,  oi 
every  two  months,  as  follows:  At  the  close  of  ev( 
second  month  a  new  physicians'  information  tub 
culosis  card  (140  L)  and  an  envelope  addressed 
the  physician  are  filled  out  at  the  Branch  Offi 
for  every  private  case  in  the  current  index,  and  f 
warded  to  the  Borough  Office.  From  there  they  i 
mailed  to  the  physician  with  a  stamped  envelope  ] 
return.  When  returned,  the  physician's  card  is  fil 
in  the  central  name  file  in  the  Borough  Office,  a 
the  facts  forwarded  to  the  Branch  Office,  where  tt 
are  entered  on  the  record  envelope  of  the  case.  Shoi 
the  card  not  be  returned  by  the  physician  witl 
fifteen  days,  the  Branch  Office  nurse  telephones  i 
physician  to  obtain  the  necessary  information.  Faili 
on  the  part  of  private  physicians  to  respond  on  1 

118 


ard  will  be  followed  by  a  visit  from  the  Department 
iiirse.  If  the  patient  is  no  longer  under  his  care,  a 
Liu'se  visits  the  premises  and  takes  appropriate  action. 
Vhen  a  nurse  reports  that  a  patient  is  under  the  care 
if  a  private  physician,  he  is  requested  by  letter  (Form 
15  L)  to  forward  a  certificate  to  that  effect  (Form 
14  L). 

JLASS  II  A.  CASES  REPOR^^ED  BY  NON- 
DEPARTMENT  TUBERCULOSIS  CLINICS  IN 
THEIR  OWN  DISTRICT  (MANHATTAN 
ONLY). 

Sec.  137.  These  cases  are  not  assigned  to  Depart- 
oent  district  nurses  except  on  request.  The  envelopes 
if  such  cases  are  kept  in  the  current  file  under 
Clinic,"  and  comparison  made  with  the  records  of  the 
ilinic  at  stated  intervals.  On  the  first  visit  to  the  home 
f  each  new  clinic  case  the  non-Department  clinic 
furse  fills  in  blue  card  (Form  149  L)  with  information 
bout  house  conditions  required  for  house  file  in  the 
Jranch  Office.  These  cards  as  completed  are  turned 
ver  to  the  district  nurse,  who  forwards  them  to  the 
{ranch  Office.  If  the  case  is  not  found  at  the  address 
iven,  the  cards  are  shifted  from  "clinic"  to  "not 
ound"  section  of  the  current  file. 

The  clinic  may  request  that  district  nurses  visit  its 
ases  (1)  to  order  disinfection;  (2)  to  induce  patient 
3  return  to  clinic;  (3)  to  recommend  forcible  re- 
loval. 

When  a  complaint  regarding  one  of  this  class  of 
linic  cases  is  received  at  the  Branch  Office,  the  clinic 
3  always  consulted  before  patient  is  visited.  When 
ases  of  tuberculosis  are  discharged  by  the  clinic  for 
on-attendance  or  any  other  reason,  they  come  under 

119 


the  care  of  the  district  nurses  and  become  "at  home 
cases.     (See  Sec.  141.) 

[Note. — When  a  clinic  reports  a  case  as  living  i: 
another  district,  and  unless  the  report  states  tha 
the  first  clinic  wishes  to  keep  the  case  under  treat 
ment,  a  district  nurse  visits  the  patient  at  once,  an 
urges  the  patient  to  attend  the  proper  clinic 
patient  does  not  report  at  second  clinic  within  te 
daj^s,  he  is  revisited  and  again  urged  to  attend  clini 
If  he  refuses  to  do  so,  he  is  then  classified  as  an  "a 
home"  case.  If  patient  does  report  at  clinic,  he 
treated  as  a  clinic  patient.] 

CLASS     II  B.       CASES     ATTENDING    OTHER 
CLINICS. 

The  name,  address  and  clinic  attended  of  ever 
patient  attending  a  clinic  outside  of  his  distri< 
should  be  entered  on  a  "transfer  and  receipt"  car 
(Form  SOL)  and  filed  among  the  clinic  cases  in  tt 
Branch  Ofiice  of  the  clinic  attended.  Such  cases  ai 
to  be  reported  to  the  clinic  of  the  district  of  res 
dence  and  recorded  in  the  name  file  of  said  clini 
together  with  the  name  of  the  clinic  actually  attend© 
Should  such  a  patient  later  attend  the  clinic  of  h 
district,  the  name  file  will  make  known  that  a  clin 
history  is  already  on  file  in  some  other  clinic,  ai 
the  same  can  then  be  sent  for. 


ii 


CLASS     III.  CASES     ADMITTED    TOi    HOSPITA 

Sec.  138.     When  word  is  received  from  the  Borou? 

Office  that  a  case  in  the  district  has  entered  a  ho 

pital,  the  name  of  hospital  and  date  of  admission  a; 

entered  on  the  record  envelope  and  the  case  reclassifii 
in  the  index.   The  later  history  card  is  assigned  to  tl 

120 


arse,  who  visits  the  premises  and  orders  the  neces- 
iry  disinfection.  This  applies  to  all  clinic  as  well 
s  iit  home  cases.  A  "home  condition"  card  (Form 
i4L),  stating  wliether  patient  should  be  allowed  to 
^tnrn  home,  is  filled  out  by  the  nurse  for  every 
ise,  and  mailed  direct  from  the  Branch  Office  to  the 
[ospital  Admission  Bureau.  The  same  procedure  is 
allowed  in  dead  cases,  except  that  the  case  is  re- 
loved  from  current  file. 

LASS  IV.  CASES  LEAVING  CITY  TEMPORARILY 

OR  ENTERING  SANATORIA. 
Sec.   139.     Here   the  procedure  is  the  same  as   in 
ases  entering  hospital,  the  cases  being  subdivided  into 
a)  out  of  town;  and  (b)   in  sanatoria. 

CLASS  V.     CASES  NOT  FOUND  AT  ADDRESS 
GIVEN. 

Sec.  140.  Every  effort  is  made  by  the  district 
urse  to  locate  the  patient.  Should  this  be  impossible, 
iie  reason  is  given,  e.  g.,  "no  house  at  that  address" ; 
only  a  friend's  address,  never  lived  here  and  where- 
bouts  not  known"  ;  "never  heard  of  at  that  address" ; 
lived  here  months  or  years  ago,"  etc. 

If  informed  that  patient  is  dead,  the  nurse  uses 
very  effort  to  learn  v/here  and  when  patient  died. 
l11  cases  reported  "not  found"  are  reinvestigated  by 

second  nurse.  W^hen  a  "not  found"  case  is  re- 
orted  from  another  address  in  another  district,  that 
act  must  be  reported  to  the  original  Branch  Office 
y  the  Borough  Office,  in  order  that  original  records 
lay  be  transferred.  At  the  end  of  one  year  the 
ecords  of  "not  found"  cases  not  subsequently  re- 
orted  are  removed  from  the  current  to  the  discon- 
tnued  file. 

121 


CLASS  VI.     "AT  HOME"  CASES. 

Sec.  141.  Under  this  head  are  included  cases  re- 
ported by  general  dispensaries,  those  discharged  from 
hospitals,  sanatoria  and  tuberculosis  clinics,  those 
reported  by  private  physicians  with  request  that 
they  be  visited,  etc.  [All  cases  discharged  from 
Riverside  Hospital,  in  which  the  home  or  other  con- 
ditions have  been  previously  reported  as  unsatisfac- 
tory and  retention  of  the  patient  is  recommended,  are 
to  be  reinvestigated  at  once.  The  return  of  the 
patient  to  Riverside,  by  force  if  necessary,  is  to  be 
recommended  if  such  action  is  warranted  by  the 
result  of  the  investigation.  Such  discharged  cases  are 
reported  by  letter  direct  from  the  Admission  Bureau 
to  the  Branch  Office.]  The  patients  are,  of  course, 
urged  to  attend  the  tuberculosis  clinic  of  the  district, 
and  should  they  do  so  they  become  clinic  cases.  Until 
the  sanitary  conditions  are  satisfactory,  and  instruc-^ 
tions  are  obeyed,  each  case  is  visited  every  few  days ; 
thereafter,  at  least  once  every  two  months.  The 
record  envelopes  and  the  tally  index  in  the  Branch  Of- 
fice call  attention  to  any  case  being  overlooked.  A  new 
later  history  card  (Form  267  L)  is  assigned  to  the 
district  nurse,  and  returned  the  following  day.  All 
necessary  facts  are  then  entered  on  house  card.  If 
sanitary  conditions  are  satisfactory,  the  later  history 
card  is  filed  in  the  record  envelope  in  the  current  in- 
dex. If  case  is  kept  under  supervision,  it  is  kept  in 
the  front  of  nurse's  section  of  the  index. 

DEAD  CASES. 

Sec.  142.    All  deaths  from  tuberculosis  are  reported 

to  the  Borough  Office  by  the  Bureau  of  Records  (see 

Sec,  65),  and  thence  to  the  proper  Branch  Office  on 

122 


]y  report.  The  record  envelope  is  stamped  "Dead," 
1  imless  patient  died  in  a  hospital,  the  later  history 
(1  is  assigned  to  the  district  nurse  to  order  the 
I  essary  disinfection,  etc.  On  receipt  of  nurse's 
r  )ort  that  disinfection  has  been  attended  to,  the 
erelope  with  the  liistory  card  is  removed  from  the 
creiit  file,  all  facts  entered  on  the  record  envelope 
i  bouse  card,  and  the  envelope  and  history  cards 
I  i  t■o^^yarded  to  the  Branch  Office.  A  list  of  the 
ciths  is  forwarded  at  once  to  the  Hospital  Admis- 
&  n  Bureau.  A  record  is  kept  of  the  number 
t  previously  unreported  dead  cases  on  daily  tally 
5  9et.  In  all  previously  unreported  cases  where 
ti  physician  signing  the  death  certificate  had  been 
i  attendance  one  week  or  more,  a  letter  (Form  25  L) 
i  sent  by  the  Physician-in-charge  to  said  attending 
tysician  calling  his  attention  to  the  violation  of  the 
'nitary  Code  and  requesting  an  explanation.  Should 
t.  answer  be  received  within  two  weeks  to  two  such 
I  ters,  a  third  letter  is  forwarded  to  the  Executive 
Ifice,  with  recommendation  that  it  be  delivered  by  a 
(Qitary    policeman,    demanding    an    explanation    on 

I  in  of  prosecution. 

RECOVERED    CASES. 

Sec.  143.     Before  a  case  can  be  removed  from  the 
irrent  tuberculosis  files  of  the  Department,  as  ap- 

I I  ently  arrested,  all  constitutional  symptoms  and 
]  ectoration  with  tubercle  bacilli  must  have  been 
-ent  for  a  period  of  three  months,  the  physical 
/!  s  to  be  those  of  a  healed  lesion.  On  receipt  of 
0  attending  physician's  certificate  of  this  condition 
"orm  87  L)  the  Borough  Office  is  notified  to  remove 
sf;  from  its  own  and  Branch  Office  files. 

123 


CASES  LEAVING  THE  CITY  PERMANENTLY. 

Sec.  144.  As  in  dead  cases,  these  cases  are  at  one 
assigned  to  the  district  nurse  to  order  the  necessar; 
disinfection,  and  the  record  envelope  removed  froi 
the  current  file  and  placed  in  the  discontinued  file. 

UNDIAGNOSED  CLINIC  CASES. 
Sec.  145.  When  patients  under  observation  in  th 
Tuberculosis  Clinics  fail  to  attend  until  a  diagnosi 
can  be  made,  they  are  visited  by  a  nurse  and  urgei 
to  return.  Should  they  fail  to  do  this  they  are  vij 
ited  by  the  attending  physician,  who  endeavors  t 
arrive  at  a  diagnosis. 

SCPIOOL    CHILDREN. 

Sec.  146.  Each  Borough  Office  records  the  numbe 
of  reported  cases  and  deaths  from  tuberculosis  ii 
children  from  0-5  and  5-16  years  of  age.  All  case 
and  deaths  of  children  of  school  age  are  reporte( 
from  the  Branch  Office  to  the  Executive  Office  (Forr 
126  L),  where  further  investigation  is  made  as  t< 
exclusion  from  school.  All  cases  of  children  of  schoo 
age,  with  tubercle  bacilli  in  the  sputum,  are  reporte( 
by  the  Diagnosis  Laboratory  to  the  Executive  Office 

Children  whose  sputum  has  shown  the  presence  o 
tubercle  bacilli  within  two  months  are  not  permittee 
to  attend  school.  If  they  are,  or  have  been,  attend 
ing  public  schools,  the  Bureau  of  Child  Hygiene  ii 
requested  to  exclude  them,  a  special  card  (Form  83  L; 
being  used   for   that  purpose. 

In  cases  attending  private  or  parochial  schools  th< 
same  procedure  is  followed. 

In  cases  under  the  care  of  private  physicians,  in 
formation  is  obtained  from  the  physician  as  to  resuli 

124 


'  private  sputum  examination  and  location  of  school 

tended.    A  specimen  of  sputum  is  also  asked  for. 

Cases    suffering   from    tuberculosis,    whose    sputum 

jes  not  contain  tubercle  bacilli  or  cannot  be  exam- 

led,    are    referred    to    the    Bureau    of    Child    Hy- 

ene   for   exclusion    only    when    there    are   physical 

gns  of  disease,   the  child  is  in  poor  condition  and 

le  parent   or  guardian   consents.     Where   the   child 

admitted  to  or  discharged  from  a  day  camp,  the 

tacher  at  the  camp  is  expected  to  notify  the  school 

iithorities  to  transfer  the  child  from  or  to  its  reg- 

lar  public  school,  as  the  case  may  be. 

-  When    the    patient    improves    and    examination    of 

vo  consecutive  specimens  of  sputum   fails   to   show 

le  presence  of  tubercle  bacilli,  the  Bureau  of  Child 

3'giene  is  requested  to  permit  the  child  to  return  to 

•hool. 

The  Bureau  of  Child  Hygiene  is  furnished  period- 
ally  with  information,  obtained  from  the  district 
iberculosis  nurses,  regarding  the  whereabouts  of 
rery  case  of  tuberculosis  excluded  from  school,  if 
iider  medical  care,  and  by  whom.  The  nurses  make 
rery  effort  to  induce  all  suitable  cases  to  enter  a 
ay  camp,  or  an  institution. 

A8ES      REPORTED      AS      LIVING      IN      OTHER 
BOROUGHS. 

Sec.  147.  These  are  at  once  reported  to  the  Bor- 
igh  Office  of  the  Borough  in  which  they  live.    When 

patient  moves  to  a  definite  address  in  another 
orongh,  the  original  records  are  forwarded  to  that 
^jrough  Office  through  the  Executive  Office  of  the 
ureau. 

125 


SUSPECTED  CASES  AND  COMPLAINTS. 


f 


Sec.  148.  All  cases  reported  by  lay  individuals  and 
organizations,  and  nurses,  are  classed  as  "suspected" 
cases,  and  are  referred  by  the  Borough  Office  to  the 
proper  Branch  Office,  where  they  are  first  assigned 
to  the  district  nurse  for  investigation.  She  forwards 
a  history  (Form  44  L),  and  endeavors  to  induce  the 
patient,  if  not  under  a  physician's  care,  to  attend 
her  clinic ;  failing  in  that  she  obtains  a  specimen  of 
sputum.  If  she  cannot  do  this,  the  case  is  assigned 
to  a  clinic  physician.  Should  there  be  a  physician 
in  attendance  who  has  failed  to  report  the  case,  he  is 
communicated  with  by  telephone  or  letter. 

If  not  a  case  of  tuberculosis,  it  is  classed  as  "no 
case"  and  not  entered  in  current  record  file,  history 
card  being  filed  in  Branch  Office.  All  complaints  by 
citizens  (as  to  spitting,  necessity  for  hospital  treat 
ment,  etc.)  are  first  investigated  by  a  tuberculosis 
nurse,  who  submits  a  history  card  with  report.  If 
there  is  a  physician  in  attendance,  he  is  commu 
nicated  with  and  requested  to  see  that  the  nuisance 
is  abated  if  one  exists.  Complaints  by  nurses  or 
physicians  as  to  unsanitary  conditions  and  recom 
mending  inspection  are  forwarded  on  special  blank 
(Form  3L).  The  report  is  journalized,  approved 
by  Physician-in-charge,  and  forwarded  to  Executive 
Office.  If  a  tenement  house,  the  complaint  goes  to 
Tenement  House  Department;  if  a  one  or  two-family 
house,  to  the  Sanitary  Bureau  of  the  Department. 

All  reports  of  cases,  either  to  the  Executive  Office, 
or  to  private  physicians  or  outside  organizations, 
should  be  made  on  the  card  furnished  for  that  pur- 
pose   (Form  87  L). 

126 


1 


NVESTIGATION  OF  SUSPECTED  CASES  OF 
TUBERCULOSIS  AND  COMPLAINTS. 

lec.  149.  All  suspected  cases  of  tuberculosis  that 
;\1  not  or  cannot  visit  a  clinic,  and  in  which  the 
itrict  nurse  cannot  obtain  a  specimen  of  sputum, 
I  examined  at  their  homes  by  a  clinic  physician. 
E?se  cases  are  reported  to  the  Department  by  lay 
)  anizations,  citizens,  district  nurses,  inspectors  of 
)  er  city  departments,  etc.  The  physician  submits 
1  ull  report  of  the  case  on  a  history  clinic  diagram 

d    (Form  211  L).  ^ 

ill  suspected  cases  of  tuberculosis  (permanent  cen- 
i  cases,  special  complaints,  etc.),  if  not  on  record 
ithe  Branch  Office,  are  to  be  assigned  immediately 

a  clinic  physician  for  investigation,  and  a  report 
Lsto  be  forwarded  at  once  to  the  Executive  Office. 
le  visiting  physician  must  examine  the  patient 
f^enever  possible,  and  not  rest  content  with  referring 
ba,  or  her,  to  the  clinic.  Should  disinfection  be 
D-essary,  a  nurse  should  be  sent. 

[ICOMMENDATIONS     FOR     CHARITABLE     AID. 

5ec.  150.  When  made  by  district  nurses  in  districts 
r  ere  there  are  no  local  relief  committees,  these  are 
^warded  direct  from  the  Branch  Office  by  double 
r-^tiil  (Form  81  L)  to  the  proper  Association.  A 
r:ord  (Form  42  L)  is  kept  of  every  reference,  and 
\ien  the  return  postal  is  received  and  entered  on 
r.ord  of  case,  it  is  filed  behind  tally  card.  At  in- 
tvals  a  second  postal  is  sent  for  each  case  in  which 
1   reply  has  been  received. 

127 


RECOMMENDATIONS  FOR  HOSPITAL  CARE. 

Sec.  X51.  When  these  are  received  on  nurses'  ( 
physicians'  histories,  duplicate  reference  cards  (Forj 
1Y4L)  are  forwarded  to  the  Hospital  Admissio 
Bureau. 

Applications  for  sanatoria,  the  Preventorium,  ( 
Department  Day  Camps,  are  made  only  by  the  tube 
culosis  clinic   of   the   district. 

SUPERVISION  OF  FAMILIES  OF  CASES   IN 
HOSPITAL. 

Sec.  152.  When  patients  in  a  hospital  have  famili* 
remaining  at  address  from  which  patient  enters  ho 
pital,  those  families  are  visited  at  intervals  by  di 
trict  nurses  to  obtain  information  for  Hospit; 
Admission  Bureau  as  to  whether  patient  should  1 
allowed  to  return  home  from  the  hospital. 

SANITARY    SUPERVISION    OF    TUBERCULOSi; 
DISINFECTION. 

Sec.  153.  Every  case  reported  as  having  been  te 
minated  at  a  given  address  (removals,  previous  a< 
dresses  of  new  cases,  deaths,  admissions  to  hospital 
etc.)  is  at  once  assigned  to  the  district  nurse,  wl 
recommends  the  necessary  renovation,  fumigation  an 
disinfection  of  the  rooms,  such  recommendations  beii: 
noted  on  later  history  card. 

KINDS    OF    DISINFECTION    ORDERED. 

Sec.  154.  According  to  the  conditions  of  the  preu 
ises  the  nurse  may  recommend:  (a)  that  nothing  t 
done ;  this  is  most  exceptional,  obtaining  only  1 
very  recently  renovated  apartments  and  those  whei 
the  patient  only  spent  one  or  two  nights  on  the  preu 

128 


^s-  if  the  premises  are  in  good  condition  and  the 
iit'nm  examhiation  is  negative,  a  thorough  cleansing 
)cl  airing  is  sufficient;  (b)  that  the  whole  apartment 
the  room  occupied  by  the  patient  be  fumigated  with 
rmaldehyde.  (This  is  to  be  ordered  only  when  reno- 
tion  cannot  be  performed,  because  of  the  family 
maining  on  the  premises,  etc.)  ;  (c)  that  the  pa- 
int's room  be  thoroughly  renovated;  the  walls 
ashed  and  rekalsomined,  repapered  or  repainted,  and 
e  woodwork  and  floors  be  washed  and  repainted; 
1)    that  the  whole  apartment  be  renovated. 

RENOVATION    PROCEDURE. 

Sec  155.  When  renovation  is  required,  a  Renova- 
on  Request  (Form  157  L)  is  left  by  a  nurse  with 
le  janitor. 

A  re-inspection  is  to  be  made  in  ten  days.    If  work 
IS    not   been   begun,    and    the   indications    are   that 
will  not  be,  the  nurse  will  fill  out  a  Renovation 
omplaint    (Form    48  L).     This    complaint   is    to    be 
)rwarded   through   official   channels   to   the    Superin- 
>ndent  of  Nurses.    The  Superintendent  of  Nurses  ob- 
lins   from   the   Complaint   Clerk   of   the   Borough   a 
umber,  which  is  written  on  the  complaint,  and  said 
omplaint  is  then  forwarded  to  the  Chief  of  the  Di- 
ision  of  Tuberculosis.     Upon  his  approval,  the  com- 
laint   is   forwarded   to   the    Bureau   of   General   Ad- 
ilnistration   for  record,   and  for  the  issuance  of  a 
:enovation  Notice  (Form  14  E).    A  copy  of  the  Reno- 
ation  Notice,  when  issued,  is  returned  to  the  Superm- 
endent  of  Nurses,  to  be  forwarded  by  her,  through 
fficial   channels   to   the   proper   Branch    Office.     The 
rf-mises  are  Inspected  eight  days  after  the  Renova- 
ion  Notice  is  issued.      If  the  Renovation  Notice  has 

129 


not  been  complied  with,  or  work  is  not  progress! 
endorsement  to  that  effect  is  entered  upon  the  Not 
by  the  nurse,  and  it  is  returned  through  oflScial  ch 
nels  to  the  Superintendent  of  Nurses,  who  forwai 
it  directly  to  the  office  of  the  Corporation  Couni 
Upon  its  receipt,  by  the  Corporation  Counsel,  a  Oo 
sel's  Notice    (Form  5  D)   is  sent.     After  forty-elj 
hours,  the  Renovation  Notice  is  returned  directly 
the  Superintendent  of  Nurses,  who  forwards  it  throi 
official  channels  to  the  Branch  Office  for  re-inspecti 
by  a  nurse.    If  the  notice  has  not  been  complied  w 
or  work  is  not  progressing,  it  is  returned  to  the  Oh 
of  Division  and  referred  by  him  to  the  Lieutenant- 
Command  of  the  Health  Squad,  who  details  a  patr 
man  to  warn  the  person  against  whom  the  notice  is 
sued.     If,  upon  re-inspection  by  a  patrolman  of  1 
Sanitary  Squad,  it  is  found  that  work  has  not  co 
menced,  a  summons  is  issued  by  him.    Applications  1 
extension  of  time  or  relief  from  orders  are  to  be  ma 
by   the  applicant,   in  proper   form,   and   if   appro'v 
by  the  Chief  of  the  Tuberculosis  Division,  are  to 
so  endorsed  and  forwarded  to  the  Bureau  of  Genei 
Administration.     Renovation   Notices,   when  compli 
with,  are  to  be  so  endorsed  and  forwarded,  throu 
official  channels,  to  the  Bureau  of  General  Admin 
tration,  for  distribution  to  the  proper  Borough  Offi( 
for   filing. 

SCRUBBING  OF  FLOORS  AND  WOODWORK. 

Sec.  156.  In  all  instances  where  this  is  the  or 
procedure  recommended  by  the  nurse,  she  must  ma 
every  effort  to  induce  the  janitor  to  perform  the  wo 
voluntarily  without  the  issuance  of  a  notice.  Shou 
she  fail   to  obtain  this  result,   she  must  forward 

130 


eport  on  the  regular  renovation  blank  (Form  48  L), 
laking  a  report  and  recommendation  in  a  manner 
xactly  similar  to  a  case  whefe  a  notice  would  be 
isned,  except  that  after  the  recommendation  the 
ollowing  statement  is  to  be  made:  "Inasmuch  as  I 
,ave  been  unable  to  obtain  voluntary  compliance  vrith 
liis  recommendation,  I  would  further  recommend  that 
he  scrubbing  of  floors  and  woodwork  be  enforced 
y  the  Sanitary  Police." 

PLACARDS. 

Sec.  157.  When  there  is  reason  to  believe  that  reno- 
ration  will  be  evaded,  and  in  every  case  where  the 
remises  are  vacated  by  the  death  or  removal  of  the 
latient  and  renovation  has  been  ordered,  the  nurse 
,aust  placard  the  door  of  the  apartments  with  a  poster 
Form   113  L). 

A  duplicate  placard  is  to  be  forwarded  to  the 
yhief  of  Division.  The  Lieutenant-in-Command  of 
he  Health  Squad  is  then  requested  (Form  52  L)  to 
nstruct  a  sanitary  policeman  to  visit  the  premises, 
e-placard  same  if  original  placard  has  been  removed, 
md  warn  the  tenant  and  janitor  not  to  remove  same. 
Vhen  a  nurse  removes  a  placard,  she  leaves  a  notice 
'Form  55  L)   for  the  policeman. 

VOLUNTARY  RENOVATIONS. 

Sec.  158.  When  owner  or  agent  voluntarily  per- 
orms  renovation,  that  fact  is  reported  and  the  nurse 
evisits  the  house  at  short  intervals  until  work  is 
[one,  a  record  being  kept  of  the  number  of  such  vol- 
intary  renovations. 

131 


CLEANERS    AND    SCRUBWOMEN. 

Sec.  159.  A  staff  of  cleaners  or  scrubwomen  hi 
been  established  to  wash  and  clean  the  floors  an 
woodwork  of  premises  occupied  by  persons  sufferii 
from  pulmonary  tuberculosis.  These  cleaners  ai 
attached  to  the  various  clinics  aud  Branch  Ofiice 
and  their  outside  work  is  assigned  to  them  by  tl 
Physician-in-charge. 

The  district  nurse  meets  the  cleaner  on  the  prec 
ises,  gives  her  the  necessary  instructions,  sees  thj 
the  work  is  performed  properly,  and  submits  a  repo: 
of  the  same.  Such  cleaning  is  ordered  by  the  nurs 
in  cases  where  the  family  either  will  not  or  cannc 
do  it,  and  where,  for  any  reason,  the  patient  shoul 
not  be  removed   to  a  hospital. 

FORCIBLE  REMOVAL  OF  CASES   OF   PUL- 
MONARY TUBERCULOSIS. 

Sec.  160.  Recommendation  that  a  given  case  < 
pulmonary  tuberculosis  be  removed  to  a  hospital,  I 
force  if  necessary,  on  the  ground  that  the  patiei 
is  a  menace  to  the  health  of  others,  is  made  by  tl 
district  nurse,  all  complaints  being  assigned  to  h( 
for  investigation.  Before  recommending  such  forcib 
removal  of  a  case  of  pulmonary  tuberculosis,  tl 
nurse  endeavors  to  obtain  the  patient's  consent 
enter  a  hospital.  The  grounds  for  the  forcible  r 
moval  to  hospital  of  a  case  of  pulmonary  tuberculos 
are:  (a)  that  the  patient's  sputum  contains  tuberc 
bacilli;  (b)  that  the  patient  either  will  not  or  cann 
observe  the  necessary  precautions  as  to  disposal 
sputum;  and  (c)  that  others  (especially  children)  a 

132 


posed  to  infection.  Should  the  nurse  find  that  all 
above  conditions  exist,  the  Physician-in-charge 
bmits  a  special  report  (Form  64  L),  recommending 
»  removal  of  the  patient.  This  is  forwarded  to  the 
ief  of  Division.  When  approved  by  him  later,  and 
len  the  Hospital  Admission  Bureau  arranges  for  a 
ancy  at  Riverside  Hospital,  the  original  papers  are 
•warded  to  the  hospital,  to  be  returned  thence  with 
^tort,  on  discharge  or  death  of  patient.  The  Physi- 
:■  n-in-charge  makes  all  necessary  arrangements.  He 
:;t  telephones  to  the  office  of  the  Borough  OflSce  for 
1  policeman  to  meet  him  at  the  patient's  home. 
:  then  visits  patient,-  and  if  the  latter  is  still  on 
;  premises  leaves  him  or  her  in  care  of  the  police- 
m  while  he  telephones  direct  to  the  Borough  Office 
)  the  Department  for  an  ambulance.  Returning  to 
.  premises,  he  there  awaits  the  arrival  of  the  ambu- 
ice.  If  in  his  opinion  the  patient  is  in  a  dying 
jidition,  he  suspends  removal. 
Vhen  it  is  desired  that  patients  who  have  entered 
^erside  Hospital  voluntarily,  be  detained  there,  a 
•lommendation  to  that  effect  is  forwarded  to  the 
Urd  of  Health  for  its  approval. 

UPERVISION  OF  CASES  AT  THEIR  HOMES. 
GENERAL  PROCEDURE. 

ec.  161.  The  first  duty  of  the  tuberculosis  district 
!  of  the  Department  is  to  exercise  the  necessary 
iry  supervision  over  the  cases  of  pulmonary 
ulosis  living  in  her  district.  Almost  the  first 
ion  asked,  when  making  a  visit  to  a  new  case, 
I  other  the  patient  is  under  the  continued  care 

I  private  physician;  if  so,  his  name  and  address 

133 


are  obtained.     In  tracing  cases  on  first  visit,  or, 
unable  to  obtain  admission,  when  making  a  revii 
no  messages  are  left  with  neighbors.     The  reason 
the  nurse's  visit    (i.  e.,  that  there  is  a  consumpt 
on  the  premises)    is  only  to  be  given  to  the  fan; 
and  not  in  the  presence  of  visitors  or  strangers, 
possible.     The  nurse  furnishes  the  Departm^t  w 
prompt,  accurate  and  sufficiently  frequent  reports 
to  where  the  patient  is,  his  general  condition,  tempe 
ture  and  pulse,  whether  the  necessary  precautions 
being  observed  (sputum,  etc.),  if  he  is  receiving  m< 
cal  care  and  where,  the  nature  and  condition  of 
house  and  rooms  in  which  he  lives,  the  number  in 
family,  etc.     She  calls  attention  to  any  faulty  coi 
tions  and  recommends  the  steps  to  be  taken  for  tl 
betterment.    General  unsanitary  conditions  are  repi 
ed  and  the  case  is  kept  under  sanitary  supervis 
and  visited  every  few  days  until   faulty  conditi 
are  corrected  or  the  recommendations  carried  out. 
necessary,  she  may  recommend  that  a  physician  ( 

CIRCULAR  OF   INSTRUCTION. 

Sec.  162.    The  following  circulars  of  instruction 
the  language  spoken  by  the  patient,  are  given  to 
patient  or  the  family: 

1 — Folders   of   General   Information   Regarding   ( 
sumption.    Printed  in  four  languages. 

2 — Folders  of  Advice  to  Patients,  each  printed  in  I 
lish  and  one  other  language;  three  language 


-Cards  of  Advice  Regarding  Sweeping  and  Dust! 
In  English  and  one  other  language;  three 
guages. 

134 


I 


>ESCRIPTION  OF   NURSES'   WORK   IN   HOMES. 

Sec.  163.  Any  other  suspicious  cases  of  tuberculo- 
s  among  the  family  and  neighbors  are  traced  and 
jported.     Should   the  patient  be   a   child  attending 

hool,  the  nurse  reports  whether  or  not  he  or  she 
lould  be  excluded  from  school.  The  welfare  of 
[ly  sickly  or  anaemic  children  is  looked  after  and 
ley  are  protected  against  infection  as  far  as  possible, 
necessary  their  admission   to  a  fresh  air  school, 

day  camp  or  Preventorium  is  recommended.  If 
18  rooms  are  very  dirty  and  the  occupants  cannot 
will  not  clean  them,  the  nurse  forwards  a  recom- 

endation  to  the  Branch  Office  that  a  cleaner  be  sent 
y  the  Department  (see  Sec.  159). 

If  the  patient  is  at  work,  the  nurse  reports  as  to 
hether  his   work  is   harmful  to   him,   his   presence 

menace  to  his  fellow  workmen,  or  if  he  is  likely  to 
)read  infection  to  the  public    (bakers,   handlers  of 

odstuffs,  cooks,  laundresses,  etc.).  If  any  work  is 
me  at  the  home,  the  nurse  makes  sure  that  no  one 
endangered  thereby. 

If  the  case  is  suitable  for  hospital  or  sanatorium 
.re,  she  endeavors  to  induce  the  patient  to  enter  an 
stitution  voluntarily,  and  submits  a  recommendation 
that  effect.  All  the  above  information  is  submitted 
'  the  nurse  on  the  later  history  card  (Form  44  L). 

The  patient's  temperature  and  pulse  must  be  taken 
every  visit,  or  the  reason  stated  for  not  doing  so. 
lis  applies  especially  to  observation  cases. 

The  district  nurses  may  be  called  on  to  deliver 
[mission  cards  to  tuberculosis  hospitals  (Form  32  L) 
patients,  and  instruct  them  how  best  to  reach  the 
tgpital,  and  as  to  outfit  required  (Form  227  L),  etc. 

135 


DUTIES    OF   DISTRICT    NURSES    IN   CLINICS  ^ 

Sec.  164.  In  all  tuberculosis  clinics  except  non 
Department  clinics  in  Manhattan,  which  do  their  owi  ^ 
district  nursing,  the  district  nurses  devote  a  certah 
portion  of  their  time  to  work  In  their  clinic.  Ii 
addition  to  their  regular  routine  clinic  duties,  thej 
meet  all  the  clinic  patients  from  their  own  sub-dis 
trict,  who  have  been  instructed  to  return  on  thosi 
days.  They  thus  familiarize  themselves  with  the  med 
ical  aspect  of  their  cases,  and  their  presence  tendi  (f 
to  promote  friendly  relations  between  the  clinic,  th( 
patients  and  themselves.  They  also  call  the  attendinj 
pliysicians'  attention  to  anything  specially  worthy  o 
note  regarding  the  patients  and  their  home  surround 
ings. 


HISTORY  CARD. 


Sec.  165.     This  card   (Form  44  L)   gives  a  descrip 
tion  of  the  house,  the  rooms,  the  family,  the  financia 
conditions,  the  physical  condition  of  the  patient,  pre 
cautions  observed,  instructions  given,  and  any  recom  ia 
mendations. 


One  of  these  cards  is  given  out  for  every  ne\ 
assignment  (including  dead  cases,  those  removed  t 
hospital  or  sanatoria,  etc.,  etc.).  Very  often  patient 
will  give  the  address  of  a  friend  or  relative  with  whor 
they  have  never  lived.  The  history  card  need  not  b 
filled  out  in  such  cases,  unless  the  patient  be  seer 
A  new  card  is  assigned  whenever  patients  chang 
their  address,  return  home  after  a  considerable  at 
sence,  or  when  conditions  at  the  home  have  changec 
In  many  instances  only  the  description  of  the  hous 
can  be  given,  as  the  rooms  cannot  be  located.     Bu 

136 


7en  tliis  scanty  information  is  important,  as  it  is 
squired  for  the  house  file  at  the  Branch  Office.  This 
istory  card  is  also  used  by  a  number  of  the  non- 
lepartment  clinics  of  Manhattan  Association  of  Tu- 
Brculosis  Clinics. 

When  cases  under  care  of  private  physicians  or 
on-Department  tuberculosis  clinics  are  visited  to  or- 
er  disinfection,  etc.,  only  the  house  history,  location 
f  rooms,  how  long  the  family  has  been  in  rooms, 
revious  address,  and  name  and  address  of  physician 
r  clinic  caring  for  patient  are  entered  on  the  card. 
;ut  when  such  cases  are  visited  on  complaint,  a  full 
istory  is  taken. 

The  Borough  case  number  and  year  of  old  cases 
re  always  entered  in  the  proper  space  in  the  upper 
ight  hand  corner  of  the  card. 

DISTRICT    WORK    OF    CLINIC    PHYSICIANS. 

Sec.  IGO.  As  stated  in  Section  149,  the  clinic  physi- 
ians  do  district  visiting  in  addition  to  their  clinic 
rork.  The  assignments  are  made  by  the  Physician- 
i-charge,  and  all  reports  submitted  on  a  clinic 
iagram  card  (Form  211  L).  A  record  of  the  visits 
J  kept  in  the  Branch  Office,  and  given  in  its  weekly 
eport. 

TUBERCULOUS  CHILDREN. 

Sec.  167.  Cases  of  pulmonary  tuberculosis  in  chil- 
ren  under  sixteen  years  of  age,  in  which  the  attend- 
ig  physician  will  not  certify  in  writing  that  patient 
an  safely  attend  school,  where  the  patients  will 
ot  or  cannot  visit  the  nearest  Department  Tuber- 
ulosis   Clinic,   or   where    a    specimen   of   sputum   is 

137 


refused,  may  be  assigned  to  a  clinic  physician  for  in 
vestigation  and  report.  In  investigating  cases  re 
ported  by  tuberculosis  clinics  for  exclusion  or  re 
admission  to  school,  the  physician  will  consult  witl 
and  obtain  all  information  possible  from  the  clinii 
before  visiting  the  child. 

VISITS    TO   LODGING    HOUSE   PATIENTS. 

Sec.  168.  Monthly  visits  to  patients  living  in  lodg 
iug  houses  are  made  by  the  clinic  physicians  on  re 
quest  of  the  district  nurse. 

Lodging  houses  and  Mills  hotels  are  notified  (Forn 
—  L)  when  a  case  of  tuberculosis  is  reported  fron 
that  address,  and  are  required  to  inform  the  Depart 
ment  of  Health  (Form  — L)  of  the  departure  oi 
such  cases. 

VISITS    TO    CLINIC    PATIENTS. 

Sec.  1G9.  The  tuberculosis  clinics  sometimes  sem 
a  physician  to  visit  a  clinic  patient  who  is  too  11 
to  attend  the  clinic.  A  clinic  physician  visits  th( 
patient,  prescribes  if  necessary  and  forwards  a  repor 
recommending  suitable  action  (usually  removal  t< 
hospital).  But  he  does  not  continue  to  render  medica 
service  at  the  home. 

RECOVERED  CASES. 

Sec.  170.  When  notice  is  received  that  a  given  cas< 
of  tuberculosis  has  recovered,  and  no  physician's  cer 
tificate  is  forwarded,  the  case  may  be  assigned  t( 
the  clinic  physician  to  visit  and  make  a  physica 
examination. 

138 


I  FORMATION   FOR   THE   PUBLIC   REGARDING 
THE    SUPERVISION    OF    TUBERCULOSIS. 
CIRCULARS. 

Sec.  171.    The  following  circulars,  etc.,  are  issued 
I  tlie  Department,  through  its  nurses,  through  drug 
fi>res  acting  as  supply  stations,  and  through  stereop- 
ton  and  traveling  tuberculosis  exhibits,  to  persons 
tiering  from  tuberculosis  and  their  families,  to  phy- 
i  ians  and  to  others  interested :     Circular  of  Infor- 
iition  Regarding  Measures  Adopted  for  the  Sanitary 
;  per  vision  of  Tuberculosis    (Form  66  L).     Circular 
]  garding  Importance  of  Early  Diagnosis  of  Tuber- 
(iosis    (Form   75  L).     "Sweeping   and   Dusting,"   in 
;iglish  and  German  (Form  176  L)  ;  English  and  Ital- 
i    (Form  177  L),  and  English  and  Yiddish    (Form 
;jL).     Circular  of  Information  Regarding  Consump- 
in,    in    English     (Form    231 L);    German     (Form 
!0  L)  ;  Italian  (Form  238  L)  ;  Yiddish  (Form  241  L)  ; 
:»beuiian    (Form    239  L);     Finnish    (Form    107  L)  ; 
jlisb    (Form    133  L)  ;    Slovak    (Form    134  L);    Ru- 
enian    (Form   13.5  L);   Sv/edish    (Form  236  L);  Ar- 
iiiian     (Form    SOL);    Spanish     (Form    29  L),   and 
iinese    (Form  162  L).     Advice  for  Patients  in  two 
iigiiages  :     English-German   (Form  139  L)  ;  English- 
niiau    (Form    155  L),    and    English- Yiddish    (Form 
7L),      Consumption    Cures    (Form    229  L).       Con- 
niption  Cures    (in    Italian)     (Form   72  L).     Hand 
lok  of  Help  for  Consumptives    (Form  2L).     What 
)U  Should  Know  About  Tuberculosis  (Form  123  L). 
iljii'culosis   Catechism   for   Children    (Form   246  L). 
pgistration  and  Sanitary  Supervision  of  Pulmonary 
Uberculosis      (monograph     No.     1).       Tuberculosis 
linics  and  Day  Camps   (monograph  No.  2).     Metal 

139 


and  paper  signs  warning  the  public  against  spittit 
and  "Anti- Spitting  Pads"  (Form  130  L).  Leaflet  R 
garding  Reporting  of  Tuberculosis   (Form  9L). 

MOVING   PICTURE  AND    STEREOPTICON   EXH 

BITIONS. 

Sec.  172.  These  are  given  at  night  in  the  publ 
parks  throughout  the  summer,  notices  of  such  exh 
bitious  being  distributed  by  nurses,  through  drr 
stores,  etc.  These  notices  are  printed  in  English  an 
other  languages,  as  follows:  English  (Form  12 L) 
Yiddish  (Form  41  L),  and  Italian  (Form  46  L).  Pla 
ards  (Form  209  L)   are  posted  throughout  the  city. 

CARE  OF  THE  DEPARTMENT'S  TUBERCULOSI 
PATIENTS. 


THE  TUBERCULOSIS  HOSPITAL  ADMISSION 
BUREAU. 

Sec.  173.  Located  at  426  First  Avenue,  Manhattai 
in  the  immediate  neighborhood  of  the  Department  c 
Charities,  Bellevue  Hospital,  the  large  medical  school 
and  a  number  of  dispensaries.  Telephone  8667  Mac 
ison  Square.  This  Bureau  has  been  established  b 
mutual  agreement  of  the  Department  of  Charitief 
the  Department  of  Health,  and  of  Bellevue  and  Allie 
Hospitals. 

The  staff  of  the  Manhattan  Bureau  consist 
of  a  Physician-in-charge ;  a  Clerk-in-charge  and  Exaa 
iners,  detailed  from  the  Department  of  Charities;  A1 
tending  Physicians,  detailed  from  the  Department  o 
Charities  and  Health  ;  a  Dentist ;  Nurses  ;  Hospital  ani 

140 


her  Clerks.  A  special  letterhead  (Form  19  L)  and 
ivelope*  (Forms  10,  17  and  20  L)  are  used.  The 
bysician-in-charge  keeps  a  diary  of  current  events. 

A  weekly  report  (Form  190  L)  is  submitted  to  the 
'ureau  of  Infectious  Diseases  and  to  the  Department 
-;  Charities. 

s^STITUTIONS  ADMITTING  THROUGH  BUREAU. 

Sec.  174.  Tuberculosis  institutions  to  which  patients 
e  admitted  through  Bureau : 

(1)  General  tuberculosis  hospitals  maintained 
rectly  by  the  City  Government  (Metropolitan,  River- 
de  and  Sea  View). 

(2)  General  tuberculosis  hospitals  maintained  in- 
reetly  by  subsidy  [Seton,  St.  Joseph's,  St.  Vincent's 
Id  Montefiore  Home  and  Montefiore  Country  Home 
Bedford  Hills  Sanatorium)]. 

(3)  Reception  hospital  for  patients  needing  im- 
ediate  care:  (Bellevue.)  Cases  are  admitted  on 
•rsoual  application  or  are  referred  by  Admission 
ireau  when  direct  application  is  made  too  late  for 
I  mission  to  a  general  hospital  the  same  day.  The 
Iniission  Bureau  places  all  such  cases  in  other  hos- 
tels as  soon  as  possible,  except  those  which  the 
)spital  authorities  wish  to  retain. 

(4)  Sanatoria  (Otisville  and  New  York  State  Hos- 
t;il  for  Incipient  Tuberculosis  at  Ray  Brook). 

f  "O  Tuberculosis  Preventorium  for  Children,  Farm- 
i,Ml;ile,  New  Jersey;  Tuberculosis  Preventorium  at 
1 11  net,  New  York. 

(*'<)  The  Manhattan  and  Brooklyn  Day  Camps  of 
('  Department  of  Health.     [See  section  191]. 

141 


APPLICATIONS  FOR  ADMISSION. 

Sec.  175.  All  applications  for  institution  care 
whether  made  to  the  Department  of  Charities,  Belle 
vue  and  Allied  Hospitals,  the  Department  of  Health 
charitable  organizations,  tuberculosis  clinics  or  gen 
eral  dispensaries,  etc.,  are  referred,  either  directl; 
or  by  letter  or  telephone,  to  the  Admission  Bureau 
When  by  reason  of  weakness  or  other  sufficient  caus' 
the  patient  cannot  present  himself  in  person  at  th 
Bureau,  he  is  referred  for  examination  to  the  tuber 
culosis  clinic  of  that  district  of  New  York  City  ii 
which  he  resides.  If  the  patient  is  bed-ridden,  a  nurs 
or  clinic  physician  visits  the  house  and  forwards  i 
report  to  the  Admission  Bureau.  Clinics  in  referrini 
a  case  for  admission  to  hospital  forward  a  specla 
history  card   (Form  174  L). 

SYSTEM   OF  REGISTRATION. 

Sec.  176.  The  hours  of  the  Bureau  are  from  9  A.  IS! 
to  5  P.  M.  Complete  information  regarding  all  inst: 
tution  cases  of  pulmonary  tuberculosis  in  New  Yor 
City  is  kept  on  file,  a  record  envelope  (Form  109  L] 
record  card  (Form  110  L),  and  clinical  record  (Fori 
174  L)  being  used  for  that  purpose.  On  the  recor 
envelope  are  entered:  (1)  all  necessary  facts  r( 
garding  the  patient  for  identification,  case  numbe; 
etc. ;  (2)  the  date  of  application  for  institution  can 
when  and  where  admitted,  reports  from  the  hospita 
date  of  death  or  discharge,  etc. ;  (3)  similar  data  r( 
garding  all  subsequent  applications.  In  the  enveloi 
is  filed  the  record  card  of  the  case,  and  the  repoi 
of  the  district  nurse  as  to  whether  patient  should  I 
allowed  to  return  home.  Information  regarding  an 
given  case  is  thus  obtainable  at  a  moment's  notice. 

142 


3 


EXAMINATION  AT  ADMISSION  BUREAU. 

5ec.  177.  If  the  patient  applies  in  person  and  no 
rord  of  his  or  her  physical  condition  is  on  file,  a 
jf'sical  examination  is  made.  At  the  same  time  the 
ye  is  assigned  to  an  examiner  to  visit  the  patient's 
me  and  report  on  social  and  financial  conditions 
;  re.  These  examiners  are  detailed  from  the  De- 
::*tment  of  Charities.  (See  Sec.  179.)  Transients 
il  those  unsuited  for  hospital  care  are  referred  for 
-  ther  treatment  to  the  tuberculosis  clinic  of  the 
Itrict  in  which  they  reside. 

'atients  are  notified  by  card  (Form  128  L)  to  call 
I  Bureau. 

VISITS  BY  PHYSICIANS  FOR  DIAGNOSIS. 

pec.  178.  If  the  applicant  cannot  visit  the  Admis- 
tt  Bureau  in  person,  he  is  visited  and  examined  by 
of  the  clinic  physicians,  who  forwards  clinical 
ord  (Form  174  L)  to  the  Admission  Bureau.  These 
rsicians  have  received  special  training  in  the 
gnosis  of  pulmonary  tuberculosis. 

NVESTIGATION  OF  HOME  AND  FINANCIAL 
CONDITIONS. 

5ec.  179.  By  the  Bureau.  On  receipt  of  applica- 
tt  at  the  Admission  Bureau,  the  case  is  at  once 
igned  to  an  examiner  of  the  Bureau  to  visit  and 
ort  on  the  home  and  financial  conditions.  She 
[uires  into  the  conditions  of  the  house,  the  home 
the  family;  whether  overcrowding  exists;  if 
lers  (especially  children)  are  exposed  to  infection; 
cunt  and  disposal  of  expectoration;  general  con- 
ion  of  the  patient,  legal  residence,  etc.     Full  in- 

143 


formation  as  to  tlie  economic  conditions  is  also    - 
tained — amount  of  rent  paid  and  other  expenditur, 
number  to  be  supported,  the  earnings  of  each  me 
ber  of  the  family,  and  what  aid  they  are  receivi 
from    other    sources.      All    these    facts    are    reporu 
on  a  special  card  (Form  110  L).     This  is  forward 
to  the  Admission  Bureau.     Such   an  investigation 
the  social  conditions,  as  described  above,  is  made  i 
every     instance.      Physical       examination     may     > 
omitted  at  the  discretion  of  the  Bureau,  if  a  reci 
record  is  on  file. 

ADMISSION  TO  HOSPITAL. 

Sec.   180.     If  found  suitable  the  case   is  then   i- 
mitted  to  the  most  suitable  institution,  an  admiss  i 
card  being  at  once  delivered  by  a  district  nurse,  y\ 
also  gives  the  patient  full  instructions  as  to  how 
reach    the    institution,    outfit    needed,    visiting    hoi 
for  the  family,  etc.     When  necessary  an  ambulai 
or  carriage  is  provided.     If  there  are  no  vacanci, 
the  name  of  the  patient  is  placed  on  a  general  wj- 
ing  list,  a  special  card  (Form  20.3  L)  being  used. 

HOME  CONDITIONS  AFTER  ADMISSION. 

Sec.  181.     In  every  case  admitted  to  a  hospital  r 
sanatorium,  a  "home  conditions"  card   (Form  144  i 
is  forwarded  to  the  Bureau  from  the  Branch  Ofl 
of  the  district  in  which  the  patient  lives. 

If  the  patient   is   unknown    at   the   address   giv , 
"not  found"  is  entered  on  the  card.     Such  cards  ; 
assigned  to  a  nurse,  who  visits  the  hospital  and  asc- 
tains  the  correct  address.     The  card  is  then  returil 
to  the  Branch  Office  for  further  investigation. 

144 


IFPERVISION  OF  FAMILY  WHILE  PATIENT  IS 
IN  HOSPITAL. 

^ec.  182.  District  nurses  of  tlie  Department  of 
I'alth  visit  the  Families  of  patients  in  hospital  at 
uiilar  intervals,  to  obtain  correct  and  up-to-date  in- 

■mation  as  to  whether  it  is  best  for  the  patient  to 

kirn  home. 

^vEPORTS  FROM  INSTITUTIONS  REGARDING 
I  THEIR  PATIENTS. 

Sec.  183.  A  telephone  report  is  obtained  dalljr  by 
ilmission  Bureau  from  all  institutions,  of  the  numer- 
jil  census  (male  or  female)  of  patients,  and  the 
111  name  and  address  of  all  patients  admitted,  dis- 
arged,  transferred,  or  dead,  during  the  previous 
:enty-four  hours,  and  the  names  of  all  patients 
ishing  to  be  discharged  (Form  209  L).  The  num- 
r  of  vacancies  is  also  obtained  ( Form  63  L ) .  Pri- 
.te  sanatoria  report  admissions,  discharges  and 
laths  by  mail  (Form  69 L),  and  state  whether  pa- 
snts  are  to  be  visited.  This  information  is  recorded 
a  journal   (Form  8LL). 

This  information  is  telephoned  at  once  to  the 
oper  Borough  Office  of  the  Bureau  of  Infectious 
iseases  of  the  Department  of  Health. 
Each  institution  forwards  at  intervals  a  census  of 
s  patients  (Forms  208  and  257  L),  giving  name, 
ite  of  admission^  and  condition  at  the  time  of 
•port. 

HOME  COiNDITIONS  OF  RIVERSIDE  CASES. 
I 
:  Sec.   184.     In  order  to  determine  whether  patients 

lould  be  allowed  to  visit  their  homes,  every  River- 

145 


side  patient,  immediately  on  admission,  makes  api- 
cation  for  a  pass  to  leave  the  hospital.    A  special  cd 
is  used,  which  is  forwarded  from  the  hospital  to 
Admission  Bureau,  and  thence  to  the  proper  Bra 
Office  for  investigation  and  report  as  to  coudition.^ 
the  patient's  home.    The  card  is  returned  through 
Bureau   to  the  hospital.     It  does  not  supersede 
"home  conditions"  card.    Passes  are  issued  only  a 
report  on  home  conditions. 

Applicants  whose  teeth  need  attention  are  refer' 
to  the  dentist  of  the  Bureau,  card  (Form  207 L). 
suits  of  examination  and  treatment  are  entered  oa 
special  card  (Form  256  L). 

Placards  of  information  regarding  sanatorium  i- 
Quirements  are  issued  to  all  tuberculosis  cliia 
(Forms  88  and  90  L). 

SANATORIUM  APPLICANTS. 
Sec.  185.  The  Admission  Bureau  is  also  responses 
for  the  admission  of  all  cases  to  the  Sanatorium li 
the  Department  of  Health  at  Otisville,  New  Yc, 
and  to  the  New  York  State  Hospital  for  Incipiit 
Tuberculosis  at  Ray  Brook,  New  York,  and  Montefie 
Country  Home  at  Bedford  Hills.  Preliminary  md- 
cal  examination  may  be  made  at  any  of  the  tut'- 
culosis  clinics  throughout  the  city.  But  all  applicaa 
must  be  referred  to  the  Admission  Bureau  i 
economic  and  final  medical  examination.  OflSd 
examiners  for  Ray  Brook  and  Otisville  are  connect 
with  the  Admission  Bureau.  Patients  unsuitable  r 
admission  to  the  above  institutions,  or  who  woi 
have  to  wait  a  long  time  for  admission  (both  in'- 
tutions  having  waiting  lists)  are  properly  cared  * 
at  once  and  much  harmful  delay  avoided  thereby. 

146 


BUREAU  OF  INFORMATION. 

Sec.  186.  Full  and  up-to-date  information  regard- 
g  all  public,  semi-private  and  private  institutions 
r  the  care  of  tuberculosis  is  kept  on  file  at  the 

Imission  Bureau.  A  card  of  information  for  physi- 
ms  is  issued  (Form  101  L).  A  special  information 
tdex  and  waiting  list  is  kept  for  applicants  for  Otis- 
lie,  Ray  Brook,  the  Preventorium,  Seton,  and  River- 
le  hospitals  (Form  203  L),  and  clinics  and  physi- 
ms  referring  cases  are  notified  as  to  the  result  of 
e  various  examinations  and  investigations  (Form 
4  L).  A  complete  description  of  the  workings  of 
e  Bureau  is  given  in  the  Handbook  of  Help  for 
)nsumptives  (2  L)  which  is  given  out  at  the  Bureau. 


THE  TUBERCULOSIS  PREVENTORIUM  FOR 
CHILDREN,  FARMINGDALE,  N.  J. 

jSec.  187.  The  Preventorium  is  for  children  be- 
^en  the  ages  of  four  and  fourteen  who  are  predis- 
sed  to  tuberculosis,  preference  being  given  to  those 
milies  in  which  a  case  of  tuberculosis  exists. 

Applicants  must  be  examined  by  a  physician,  pref- 
ably  at  one  of  the  tuberculosis  clinics,  who  should 
I  out  and  sign  the  medical  report  blanks,  which 
ly  be  obtained  upon  written  or  personal  applica- 
m  to  the  Hospital  Admission  Bureau.  Blanks  must 
■  filled  out  in  duplicate  and  sent  to  the  Bureau.  The 
'pllcants  are  then  placed  on  a  waiting  list  from 
^lich  they  are  drawn  for  a  final  examination  by 
e  Medical  Examiner  for  Admission  to  the  Preven- 
rlum  to  determine  their  acceptance  or  rejection, 

147 


No  child  will  be  admitted  who  has  tuberculosis  U 
an  infectious  stage. 

A  tuberculin  test  must  be  made  in  every  case,  ai  ; 
a  report  of  the  result  entered  upon  the  applicatidij 
blank.  i 

No  children  who  are  known  to  have  been  exposi 
to  any  of  the  acute  contagious  diseases  within  thr< 
weeks  of  the  date  of  their  final  examination  f» 
the  Preventorium  are  eligible  at  that  time.  Tl 
presence  in  the  house  in  which  the  children  live, 
any  acute  contagious  disease  at  the  time  of  the  fini 
examination,   also  temporarily  disqualifies  them. 

Moreover,  the  presence  of  hypertrophied  tonsil 
adenoids,  carious  teeth,  or  pediculi  or  nits  in  the  ha 
may  be  a  cause  of  non-acceptance  until  such  cond 
tions  are  corrected.  In  order  to  save  time  and  lab( 
for  all  parties  concerned,  it  is,  therefore,  requestt 
that  nurses  have  these  conditions  remedied  befoj 
bringing  the  children  for  examination. 

Clinic  nurses  will  be  notified  of  the  date  of  tt 
final  examination  which  will  be  held  at  the  Hospiti 
Admission  Bureau.  Children  who  are  accepted  wi 
go  to  the  Preventorium  within  two  or  three  wee! 
of  the  date  of  their  acceptance. 

Nurses  will  be  notified  five  days  in  advance  whei 
ever  possible,  of  the  date  of  departure  for  the  Pri 
ventorium.  At  the  appointed  hour  they  must  ha\ 
their  charges  at  the  Hospital  Admission  Bureai 
From  here  the  children  are  taken  across  the  ferr 
by  the  nurse  from  the  Hospital  Admission  Burea 
to  meet  the  Preventorium  nurse.  Children  who  d 
not  appear  for  the  final  examination  when  directe 

148 


lill  be  placed  in  the  rejected  list,  unless  reason  for 
ich  non-appearance  is  promptly  furnished. 
I  Prompt  notification  to  the  Hospital  Admission 
[ureau  must  be  made  of  any  children  already  ac- 
ipted  for  the  Preventorium  who  are  found  unable 
|.go. 

Every  child  on  date  of  departure  must  be  supplied 
jith  a  complete  outfit  of  the  following  articles : 
I  One  extra  dress  or  suit  of  clothes,  1  petticoat  for 
rls,  1  extra  pair  of  strong  shoes,  1  pair  of  over- 
loes,  3  extra  pairs  of  stockings,  2  extra  suits  of 
iderwear,  nightdrawers,  1  brush  and  comb,  1  tooth 
ush. 

In  winter  (September  15- March  15)  they  require  in 
Idition : 

One  warm  coat  or  sweater,  1  pair  woolen  mittens, 
cap  covering  ears,  1  pair  rubber  boots. 

Failure  to  provide  these  will  prevent  the  child's 
?ceptance. 

All  clothing  should  be  in  good  condition  and  packed 
jatly  in  a  bundle. 

In  addition  each  child  should  have  a  light  lunch 
ifore  departure. 

Children  are  cared  for  in  the  Preventorium  for 
)out  thi'ee  months.  Clinics  and  parents  will  be 
)tified  when  children  are  to  be  returned.  They  are 
be  met  on  their  return  at  the  Hospital  Admission 
ureau  at  the  time  specified  in  the  notification. 

Discharged  cases  are  followed  up  by  a  nurse  one 
onth  after  leaving,  and  again  six  months  later.  A 
lecial  history  card  is  filled  out  and  the  result  will 
I  tabulated. 

149 


TUBERCULOSIS  INSTITUTIONS  MAINTAINED  i 
BY  DEPARTMENT  OF  HEALTH. 


RIVERSIDE  HOSPITAL. 

Sec.  188.  This  institution  is  for  a  preliminar: 
period  of  observation  (cases  with  bad  home  condition 
preferred)  of  all  applicants  for  admission  to  Otisvill 
Sanatorium ;  for  the  care  of  those  patients  who  ar 
too  far  advanced  for  Sanatorium  care;  for  the  detei 
tion  of  those  who  have  been  removed,  by  force  i 
necessary,  from  their  homes,  and  those  transferre 
from  other  hospitals  who  insist  on  returning  t 
unsuitable  home  surroundings.  The  sputum  mus 
have  contained  tubercle  bacilli  within  a  month.  Th 
hospital  is  on  North  Brother  Island,  in  the  East  Rivei 
When  a  vacancy  occurs,  admission  cards  (Form  32  L 
are  issued  by  the  nurses  of  the  Hospital  Admissio 
Bureau.  If  coup6  or  ambulance  is  necessary,  the  D( 
partment  Borough  Office  is  requested  to  remove  tt 
patient. 

All  cases  must  reach  the  Reception  Hospital  ( 
the  Department  of  Health  at  the  foot  of  East  16t 
Street,  Manhattan,  by  1  P.  M.,  as  the  boat  leaves  i 
that  hour.  Ambulatory  cases  may  cross  to  the  hospiti 
from  the  foot  of  East  132d  Street,  The  Bronx,  whenc 
a  boat  leaves  every  hour  between  9  A.  M.  and  .5  P.  L 
Information  regarding  visiting  days  and  hours 
given  in  four  languages  on  a  special  card  (For] 
31  L). 

OTISVILLE  SANATORIUM. 

Sec.  189.  For  incipient  and  favorable  cases,  j 
Otisville,  Orange  County,  N.  Y.  All  applications  ai 
referred  to  the  Hospital  Admission  Bureau.     Specif 


150 


ference  cards  (Form  71  L)  with  envelopes  (Form 
L),  giving  a  brief  history  of  the  case,  are  mailed 
duplicate  to  the  Bureau.     One  is  kept  on  file  and 

e  other  forwarded  to  Otisville  when  the  patient  Is 

Imitted.     Patients    are   admitted    according    to    the 

|[ginal  date  of  application. 

JA^pplicants  must  be  residents  of  New  York  City, 
rsons  suffering  with  tuberculosis,  who  are  not  citi- 
is  of  the  United  States,  will  not  be  placed  upon 
I  list  for  admission  to  Otisville  so  long  as  there 
J  enough  applicants,  who  are  citizens,  to  fill  vacan- 
s.  Minors,  whose  fathers  are  not  citizens  of  the 
lited  States,  will  not  be  placed  on  the  list.  The 
lowing,  however,  are  not  included: 

3l — Unmarried  women,  residents  of  the  United 
ites  for  three  years  or  more,  who  are  self-support- 
',  or  whose  parents  reside  in  foreign  countries,  and 
o  are  over  twenty-one  years  of  age. 

i — Widows,  residents  of  the  United  States  for  three 
irs  or  more. 

-Minors,  born  in  the  United  States,  or  those  not 
ive  who  are  over  fifteen  years  of  age  and  are  self- 
porting. 

Mscharged  cases  are  followed  up  and  information 
ained  as  to  their  outcome  (Form  6,5  L). 

INSTRUCTIONS  FOR  APPLICANTS. 

ec.    190.    When    vacancies    occur,    the    Admission 

•eau  notifies  the  patients  by  card   (Form  128  L) 

furnishes  them  with  a  circular    (Form  227  L), 

ng  rules  and  list  of  articles  they  must  take  with 

■n. 

151 


TUBERCULOSIS  CAMPS  AND  FRESH  AIR 
SCHOOLS. 

Sec.  191.  The  Department  of  Health  maintains  tw 
Tuberculosis  Camps  on  the  disused  ferryboats,  as  fo 
lo\YS : 

CAMPS. 


I 


1 


THE    MIDDLETOWN. 

A— Located  at  foot  of  East  91st  Street,  Manhatta 
telephone  2957  Lenox;  under  the  direction  of  tl 
Women's  Auxiliary  of  the  Department  of  Heal 
Tuberculosis  Clinics. 

THE    RUTHERFORD. 

B— Located  at  foot  of  Fulton  Street,  Brooklyn,  tel 
phone  1530  Mtiin ;  under  the  direction  of  the  Tub( 
culosis  Committee  of  the  Brooklyn  Bureau  of  Chariti< 
the  nurse-in-charge  being  in  the  employ  of  that  orgaj 
zation. 

ROUTINE  PROCEDURE. 

Sec.    192.    At   these   Camps   are    received   suital 

cases  of  pulmonary  tuberculosis  in  all  stages,  referi 

by  card   (Form  127  L)   from  Department  and  otl 

tuberculosis  clinics.    Patients  must  be  of  good  char 

ter  and  disposition,  and  residents  of  New  York  Ci 

All   patients    discontinue   attendance    at   tuberculo 

clinics  while   at  the  Camps,  but  monthly  reports 

to  their  progress  are  sent  to  the  clinics.    The  patie 

are  given  a  hot  dinner  in  the  middle  of  the  day  i 

extra  nourishment  in  the  mornings  and  afternoc 

Physicians  of  the  Department  visit  the  Camps  at  i 

ular   intervals,   examine   the   patients,    and  presci 

any    medication   necessary.     The   system   of   reco 

152 


■ed  in  the  tuberculosis  clinics  is  followed  on  the 
imps,  including  a  special  temperature  card  (Form 
.0  L).  They  are  provided  with  steamer  chairs, 
raps,  books  and  games, 

A  limited  number  of  men,  suffering  from  tuber- 
ilosis,  but  able  or  compelled  by  circumstances  to 
mtinue  at  work,  are  allowed  to  sleep  at  Camp  Ruth- 
'ford  and  are  given  a  hot  breakfast  each  morning 
:cept  Sundays  and  Holidays.  But  no  patient  can 
main  at  the  Camp  doth  day  and  night.  Such  cases 
,n  be  better  cared  for  at  a  hospital. 

TUBERCULOSIS   CAMP  NURSES. 

Sec.  193.  Nurses  assigned  to  the  Camps  perform 
e  usual  duties  of  hospital  nurses,  i.  e.,  taking  and 
•cording  the  temperature  and  pulse  of  the  patients, 
jsisting  at  meal  times,  giving  medicines,  etc. 

All   Department  employees  at  the  Camp  are  sub- 
ct   to   the  general   regulations   of  the  Department, 
the  authority  of  the  Supervising  Nurse,  and  to  the 
lecial  regulations  of  the  Camp. 

TUBERCULOSIS  CAMP  REGULATIONS. 

Sec.  194.  All  patients  must  be  referred  through 
le  of  the  twenty-nine  tuberculosis  clinics  in  New 
Drk  City.  The  reference  card  (Form  127  L),  which 
ves  the  patient's  name,  address,  clinic  number,  name 

clinic  and  other  information,  is  not  given  to  the 
itient,  but  is  mailed  in  duplicate  to  the  Boat  Camp, 
hen  a  vacancy  occurs,  a  nurse  visits  the  applicant, 
aves  an  admission  card  and  instructs  applicant  how 

reach  Camp.     One  history  is  filed  and  the  other 

153 


forwarded  to  the  Hospital  Admission  Bureau,  afte 
patient  has  either  entered  or  declined  to  enter  th 
Camp.  These  nurses  also  follow  up  and  report  oj 
delinquent  applicants  and  patients.  Patients  are  ad 
mitted  in  the  order  of  their  priority.  The  clinic  c 
reference  is  notified  by  daily  report  sheet. 

2.  No  patient  will  be  admitted  who  has  not  : 
final  diagnosis  of  pulmonary  tuberculosis,  based  o 
physical  examination,  the  presence  of  tubercle  bacili 
in  the  sputum,  or  a  positive  Moro  or  v.  Pirquet  ir 
oculation  test.  Citizens  and  children  of  citizens  wi! 
be  given  preference. 

3.  A  daily  telephone  report  of  the  previous  twentj 
four  hours  is  made  to  the  Admission  Bureau,  of  th 
name  and  address  of  all  patients  admitted  and  dis 
charged,  and  the  total  number  of  patients  at  th 
Camp.  All  children  of  school  age  who  are  admitte 
to  or  discharged  from  the  Camps  are  separately  v( 
ported  to  the  Executive  Office  of  the  Bureau  withi 
one  week  by  card,  the  full  name,  age,  addres) 
diagnosis,  etc.,  together  with  the  number  and  locatio 
of  the  school  the  child  attends,  being  given. 

4.  Daily  record  is  made  of  the  amount   of  foo 
disbursed  (Form  79  L),  and  the  reports  (Form  84  Lj 
forwarded  to  the  Executive  Office  of  the  Division  c 
Communicable  Diseases.    A  weekly  report  of  the  wor 
of  the  Camp   (Form  70  L)   is  also  forwarded. 

5.  Admission  to  the  Camp  will  be  renewed  by  th 
Supervising  Nurse  every  two  weeks.  No  patient  wi 
be  continued  who : 

(a)  has  not  attended  the  Camp  eight  days  out  c 
twelve ; 

154 


(b)  has  disobeyed  the  rules  of  the  Camp; 

(c)  has  bad  habits; 

(d)  is  dishonest. 

When  said  patient  is  attending  school  at  the  Camp, 
he  Board  of  Education  is  to  be  notified  prior  to  dis- 
■harge. 

G.  Patients  must  report  promptly  at  9  A.  M.  and 
amain  until  5  P.  M.  Those  who  are  late  will  be 
idmitted  only  at  the  discretion  of  the  Supervising 
s^urse. 

Patients  will  be  discharged  after  a  stay  of  three 
uonths  if  unimproved ;  if  improved,  they  will  be  re- 
ained  an  additional  three  months  or  longer,  at  the 

liscretion  of  the  attending  physicians. 

Delinquent  applicants  and  patients  are  investigated 
►y  the  Camp  nurses.  The  card  with  the  nurse's  re- 
)ort  thereon  is  returned  through  the  Borough  Office 
0  the  Camp. 

7.  All  patients  will  be  required  to  do  light  work; 
exceptions  may  be  made  at  the  discretion  of  the 
ittending  physicians. 

8.  Patients  who  apply  to  the  Camp  directly  with- 
iut  a  card  will  be  referred  by  the  Supervising  Nurse 
0  the  tuberculosis  clinic  of  the  district  in  which  the 
)atient  resides,  by  card  (Form  141  L),  on  which  is 
vritten  "Applicant  for  Tuberculosis  Camp." 

0.  At  each  visit  of  the  patients  to  the  Camp,  the 
ifternoon  temperature,  pulse,  and  respiration  are 
loted  on  the  treatment  card.  The  weight  is  recorded 
)nce  a  week.  Re-examination  of  the  chest  with  entry 
>n  diagram  card  is  made  at  least  once  in  every  two 

1^ 


months.     All  recommendations  must  be  made  on  { 
treatment  card  in  ink. 

10.  The  attending  physician  attends  the  Cami 
three  days  each  week  and  if  prevented  from  attending 
he  should  notify  the  Supervising  Nurse  promptly  b; 
telephone. 

11.  Nurses  report  promptly  at  9  A.  M.,  and  remaii 
until  5  P.  M. 

12.  The  nurses  assigned  to  assist  the  attendinj 
physicians  with  examinations,  etc.,  are  to  see  tha 
the  supplies  and  instruments  are  in  good  order. 

13.  Thermometers  after  use  are  wiped  with  { 
pledget  of  cotton  saturated  with  boracic  acid,  thei 
placed  in  1  to  20  carbolic  acid,  and  before  use  an 
washed  in  95  per  cent,  alcohol. 

14.  All  diagnostic  instruments  are  to  be  wiped 
after  use,  with  a  cloth  wet  with  a  solution  of  1  t< 
100  carbolic  acid. 

15.  At  the  close  of  each  examining  session  al 
histories  are  to  be  returned  to  the  oflSce  and  prop 
erly  filed.  All  sputum  specimens  are  to  be  place( 
in  the  collection  box,  and  the  office  left  in  goo( 
order. 

16.  Attending  physicians,  nurses,  hospital  helpers 
orderlies,  etc.,  will  wear  gowns  when  on  duty. 

17.  Smoking  and  the  drinking  of  intoxicatinj 
liquors  during  Camp  hours  are  strictly  forbidden. 

18.  Patients  no  longer  in  need  of  treatment  ma; 
be  discharged  by  the  attending  physician,  but  cei 
tificates  of  improvement,  recovery,  etc.,  are  to  b 
forwarded  to  the  Executive  Office  of  the  Bureau  o 
Infectious  Diseases,  to  be  issued  from  there. 

156 


TUBERCULOSIS  CLINICS. 


Sec.  195.  The  first  tuberculosis  clinic  of  the  De- 
irtment  of  Health  was  opened  March,  1904,  at  967 
xth  Avenue  (adjoining  the  headquarters  of  the  De- 
irtment  at  Sixth  Avenue  and  55th  Street),  in  a 
lilding  especially  designed  for  the  purpose.  Since 
lat  date  similar  clinics  have  been  opened  through- 
it  the  city.  For  their  location  and  hours  and  dis- 
icts  see  directory,  Sec.  2). 

OBJECTS   OF   ESTABLISHMENT. 

Sec.  196.  The  clinics  were  established  with  the  fol- 
wing  objects  in  view: 

(a)  The  early  recognition  and  accurate  diagnosis 
;  pulmonary  tuberculosis. 

(b)  The  careful  supervision  of  persons  receiving 
•eatment,  including  not  only  their  medicinal  treat- 
ent,  but  also  furnishing  them  circulars  of  informa- 
on  in  various  languages,  paper  sputum  bags  and 
iper  handkerchiefs. 

(c)  The  continued  observation  at  their  homes  by 
le  district  nurses  of  indigent,  needy  and  ambulatory 
ises,  including  all  those  discharged  from  public  in- 
itutions  of  the  city. 

(d)  The  removal  to  hospitals  or  sanatoria  of  (1) 
dvanced  or  bedridden  cases  with  profuse  expector- 
tion,  whose  presence  at  home  is  a  menace  to  others 
I  the  family;  (2)  cases  able  to  get  about  but  who 
re  unable  to  work,  and  who  are  entirely  dependent 
pon  their  earnings  for  their  livelihood;   (3)   incipi- 

157 


ent  cases,  who  stand  a  fair  chance  of  recovery  if  r 
moved  to  sanatoria  outside  of  the  city,  and  (4)  lod 
ing  house,  or  homeless  cases. 

(e)  Provision  of  municipal  institutions  to  whi< 
cases  of  tuberculosis  may  be  referred  (1)  by  phys 
cians,  (2)  by  institutions  on  discharge  therefrom,  {i 
by  the  various  charitable  organizations  throughout  tl 
city,  and  (4)  by  persons  doing  individual  charitab 
work. 

(f)  The  extension  and  strengtbening  of  the  sar 
tary  control  of  tuberculosis  among  the  poor. 

(g)  The  care  of  laryngeal  cases. 

CLINIC  STAFF. 

Sec.  197.    The  Clinic  Staff  is  organized  as  follows 

Physician-in-charge  of  the  Clinic  and  Branch  ofRc 

Attending  Physicians,  two  being  on  duty  for  eac 
class. 

Assistant  Attending  Physicians,  available  in  cas 
of  absence  of  Attending  Physicians. 

Attending  Laryngologists. 

Volunteer  Physicians. 

A  Supervising  Nurse  and  various  nurses  assigne 
to  duty  in  the  men's  clinics,  the  women's  clinics,  tii 
registration  rooms,  and  the  throat  rooms.  Thes 
nurses  also  do  regular  district  work,  dividing  thei 
time  between  the  clinic  and  the  district. 

In  Manhattan,  nurses  are  detailed  to  assist  and  d 
special  work  for  the  Women's  Auxiliaries  of  the  Tube) 
culosis  Clinics. 

158 


PHYSICIAN-IN-CHARGE    OF     CLINIC. 

Sec.  198.  The  Physician-in-charge,  in  addition  to 
ipervising  the  work  of  the  clinic  under  his  charge, 
ibmits  each  Monday  a  report  (Form  156  L)  to  the 
liief  of  Division,  giving  the  number  of  patients  seen 
jring  the  previous  week,  classifying  them  as  old,  new, 
ale  and  female,  under  observation  at  home,  receiv- 
tg  extra  diet  or  referred  to  hospitals  and  charitable 
•ganizations  and  the  number  of  prescriptions  issued, 
'taining  a  copy  (Form  112  L). 

He  submits  a  monthly  report  to  the  Association 
'  Tuberculosis  Clinics,  the  data  for  said  report  being 
itered  daily  on  a  loose-leaf  record  (Form  151 L). 

He  also  submits  an  annual  report  of  the  work  per- 
)rmed,  makes  inventories  of  stock  of  blanks  at  stated 
itervals,  and  keeps  a  diary  of  current  events. 

OiRGANIZATION. 

Sec.  199.    Each  clinic  contains  a  registration  room, 

drug  room,  waiting  rooms,  throat  department   (ex- 

?pt  in  Queens  and  Richmond),  and  clinics  for  male 

Qd  female  patients  respectively,   each   with  its  ex- 

mination  room. 

Coincidentally  with  the  establishment  of  the  new 
iuics,  the  entire  system  of  conducting  the  clinics 
as  been  revised  and  made  uniform  throughout  all 
boroughs. 

According  to  the  number  of  weekly  sessions  each 
linic  has  been  provided  with  a  corresponding  num- 
er  of  attending  physicians,  assistant  attending  phy- 
icians,  nurses,  clerks,  etc.  A  uniform  system  of 
egistration,  described  later,  is  in  use  in  all  clinics. 

159 


FURNITURE,  SIGNS,  MAi*S,  ETC. 

Sec.  200.  The  furniture  (desks,  benches,  stool; 
history  cabinets,  drug  cupboards,  etc.)  are  of  meta 
enameled  white. 

Large  wooden  signs  are  hung  on  the  walls  of  tL 
waiting  rooms,  giving  the  following  instructions  i 
English,   German,  Italian  and  Yiddish: 

DO  NOT  SPIT  ON  THE  FLOOR  OR  INTO  ANT 
THING  EXCEPT  THE  PAPER  IIANDKERCHIB 
GIVEN  YOU  FOR  THE  PURPOSE.  WHEN  YO^ 
COUGH,  HOLD  THE  PAPER  HANDKERCHIEF  BI 
FORE  YOUR  MOUTH  ;  USE  IT  ALSO  FOR  WIPIN 
YOUR  MOUTH  OR  NOSE  AFTER  SPITTING  O: 
SNEEZING.  DO  NOT  SPIT  ON  THE  FLOOR  O; 
INTO  ANYTHING  EXCEPT  THE  PAPER  HANI 
KERCHIEF,  WHICH  IS  THEN  TO  BE  PUT  IN  TH 
PAPER  BAG  AND  NOT  USED  AGAIN.  MEN  AR 
FORBIDDEN  TO  SMOKE  OR  WEAR  THEIR  HAT 
WHILE  IN  THE  CLINIC. 

« 

Framed  maps  showing  the  districts  and  locatioi 
of  all  tuberculosis  clinics  in  all  Boroughs  hang  o 
the  walls  of  the  registration  rooms.  Each  clinic  ha 
also  an  enlarged  compo-board  map  of  its  district,  o 
which  are  indicated,  by  means  of  colored  pins  (re( 
children;  blue,  adults),  the  current  cases  in  attent 
ance  at  the  clinic.  Each  clinic  is  also  furnishe 
with  a  large  framed  chart  giving  the  requirement 
of  the  various  sanatoria  receiving  cases  from  Ne^ 
York  City. 

Separate  lavatories  are  provided  for  men  and  fc 
women  patients. 

Individual  paper  drinking  cups  are  furnished  th 

160 


itients  for  drinking  purposes  and  destroyed  after 
;e. 

All  floors  and  metal  furniture  are  cleaned  every 
orning,  and  the  buildings  are  disinfected  with  for- 
aldehyde  gas  every  two  weeks.  The  gowns  supplied 
•e  disinfected  at  the  same  time,  before  being  sent  to 
le  hospital  laundry  of  the  Department  of  Health.  AH 
undry  must  be  plainly  marked  and  accompanied  by 
a  invoice. 

FORWARDING  OF  REPORTS. 

Sec.  201.  All  reports  (other  than  daily  reports  to 
ranch  Office),  time  sheets,  uotiflcations  of  absence, 
^commendations  for  exclusion  or  readmission  to 
:hool,  requisitions,  inventories,  prescriptions,  etc., 
re  forwarded  through  the  local  Branch  Office  and 
lorough  Chief  to  the  Executive  Office  at  Depart- 
lent  Headquarters.  All  blanks,  supplies,  etc.,  per- 
il ining  to  the  work  of  the  tuberculosis  clinics  are 
?sued  on  requisition,  and  all  requests  for  infor- 
mation, histories,  records,  etc.,  are  handled  by  the 
Executive  Office.  All  records  of  cases  transferred  to 
ion-Department  clinics  are  filed  in  this  office. 

)AILY   REPORT   TO    AND    FROM    THE    BRANCH 
OFFICE. 

Sec.  202.  Each  day  the  clinic  forwards  to  its 
^ranch  Office  a  report  (Form  94 L)  of  all  new  cases 
)f  tuberculosis  seen  or  diagnosed  during  the  pre- 
;eding  twenty-four  hours ;  all  cured  cases  and  those, 

previously  reported  as  tuberculosis,  found  to  be  free 
"rom  tuberculosis ;  all  changes  of  address  and  other 

..mportant  data  furnished  by  the  patients  themselves ; 

Imd  all  cases  discharged  for  non-attendance.    A  simi- 


I 


161 


lar  report    (Form  89  L)    is  received  daily  from  tt 

Branch  Office  giving  all  information  regarding  cas( 
of  tuberculosis  living  in  the  clinic  district,  receive 
at  the  Department  of  Health  during  the  precedir 
twenty-four  hours;  new  cases  reported  by  sputui 
examination,  postal  cards  from  physicians,  cod 
plaints;  all  cases  reported  by  the  Hospital  Admissio 
Bureau  as  having  entered  or  been  discharged  froi 
hospitals  or  sanatoria,  and  applicants  for  hospit? 
care;  all  deaths  from  tuberculosis;  and  all  cas( 
transferred  from  other  tuberculosis  clinics.  Thes 
cases  are  looked  up  in  the  clinic  records  and  prope 
entries  made. 

REPORTS  TO  HEADQUARTERS. 
Sec.  203.  Each  clinic  reports  daily  by  telephon 
to  the  Executive  Office  the  number  of  new  and  ol< 
cases  seen  the  previous  day,  and  absences  and  return 
to  duty  of  clinic  employees.  A  weekly  report  of  th: 
work  performed  is  also  forwarded,  and  a  monthly  re 
port  to  the  Association  of  Tuberculosis  Clinics. 

TABULATION  OF  STATISTICS. 
Sec.  204.  A  current  statistical  tabulation  shee 
(Form  268  L)  is  maintained  in  each  clinic  on  whiel 
are  entered  the  more  important  facts  regarding  ever: 
case  of  tuberculosis.  To  prevent  duplicate  tabulatioi 
when  cases  are  transferred  to  other  clinics  the  wore 
"tabulated"  is  stamped  on  the  history  envelope.  A1 
the  end  of  each  year  these  figures  are  summated. 

ROUTINE    PROCEDURE. 
Sec.  205.    The  name,  address,  age,  sex,  nationality, 
employment,  history  numher  and  clinic  class  of  every 

162 


w  applicant  is  entered  in  a  journal  (Form  218  L)  ; 

=0  the  history  number,  sex,  class  and  diagnosis  of 

lery  patient  returning  for  treatment.    The  entries  on 

( ch  day  for  morning,  afternoon  and  night  classes  have 

narate  headings.    The  totals  for  each  day  are  entered 

I    a   daily   record   sheet    (Form   73  L).     A   positive 

(ignosis  of  tuberculosis  is  only  recorded  after  being 

(Qfirmed  by    (a)    re-examination   by   another   clinic 

ysician ;    (b)    the   presence    of    tubercle    bacilli    in 

a  sputum;   (c)   re-examination  at  the  Hospital  Ad- 

;  ssion  Bureau ;  or   (d)   admission  to  a  tuberculosis 

spital  or  sanatorium.     Such  confirmation  is  entered 

:  the  journal  after  the  diagnosis.     "O.  K."  for  re- 

.amination;  "X"  for  positive  sputum. 

An  admission  card  (Form  7  L),  numbered  to  corre- 

jiid  \Yith  the  history,  with  an  envelope  for  the  same 

'orm  92  L),  a  sputum  jar  and  a  paper  handkerchief 

.  d  waterproof  bag  are  given  to  each  new  patient, 

zether  with  instructions  as  to  care  of  expectoration, 

'Ughing,  etc. 

All  information  on  the  front  of  the  primary  his- 
[■y  card  (Form  104  L)  is  obtained  by  the  registra- 
)n  room  nurse,  who  observes  the  following  instruc- 
)ns  in  taking  the  patient's  history. 

INSTRUCTIONS  FOR  HISTORY  TAKING. 
Sec.  20G.    The  clinic  case  number  is  to  be  entered 
every  instance. 

The  date  is  to  be  stamped  plainly. 

The  number  denoting  class  is  to  be  used,  but  the 

ysician's  name  is  to  be  entered  by  himself. 

The  name   and  address  of  the  patient  are   to  be 

ven  in  full,  plainly  and  correctly. 

163 


Ground  or  stoop  floor  is  "first  floor";  one  flight  ) 
is  "second  floor,"  etc. 

State  "family"  if  patient  lives  at  home;  name  I 
landlord,  if  boarding. 

Give  name  and  address  of  person  referring  patie 
to  clinic ;  use  abbreviations  if  referred  by  an  orga  - 
zation. 

Give  reason  for  coming — treatment,  diagnosis,  i 
mission  to  hospital,  Ray  Brook  or   Otisville. 

In  stating  nationality,  if  Hebrew  give  country,  e.  , 
Russ.,  Hebr. ;  if  mixed  parentage  give  both,  as  Ai 
Germ. 

Give  occupation  followed  during  period  previc? 
to  illness. 

In  obtaining  family  history,  inquire  as  to  cardii 
or   renal   disease   among  relatives   and   their  age 
death;   the  same  for  pulmonary  tuberculosis  or  a 
pulmonary   disease.    (If  all   immediate   relatives  a; 
living  and  well,  say  so.) 

Give  date  of  contact  with  any  other  case  of  tub- 
culosis. 

Inquire  carefully  as  to  colds,  sore  throat,  influen:, 
pneumonia,  pain  in  chest,  and  give  date  and  dui- 
tion. 

Inquire  as  to  other  diseases,  operations,  etc.,  w:i 
particular  reference  to  pulmonary  history.  Sc£) 
wounds  or  cut  fingers  are  not  important. 

Personal  habits  include  excesses  in  any  fori; 
drugs,  or  alcohol  to  excess  at  any  time;  do  not  wrJ 
"none"  if  history  shows  alcohol  taken  in  the  pas; 
the  same  for  tobacco. 

164 


Inquire  as  to  previous  treatmeut  In  any  hospital, 
ispensary  or  by  a  private  physician,  and  nature  of 
Iness ;  date  and  duration ;  condition  on  discharge ; 
tay  in  country,  date  and  duration,  improved  or  not ; 
ain  in  weight. 

Present  illness,  taken  generally,  means  probable 
ulmonary  tuberculosis.  Find  out  the  earliest  pos- 
ible  symptom,  such  as  loss  of  weight,  loss  of 
trength,  loss  of  appetite,  pain,  occasional  cough, 
^nvalescence  from  other  diseases  as  pneumonia, 
rphoid,  influenza,  pleurisy. 

In  inquiring  as  to  initial  symptoms  remember  that 
ulmonary  tuberculosis  does  not  begin  with  hemor- 
tiage  or  night  sweats,  and  seldom  with  cough.  Make 
nswers  cover  as  nearly  as  possible  the  whole  period 
f  illness,  and  not  only  the  day  on  which  patient 
pplies  for  treatment.  If  the  patient  wishes  exami- 
ation,  but  says  he  is  not  ill,  remember  that  unless 
e  probably  had  good  reason  for  applying  for  treat- 
lent,  he  would  not  have  done  so.  Every  patient 
m  tell  to  what  cause  he  attributes  his  illness. 

Give  the  earliest  date  when  pulmonary  tuberculosis 
ecame  evident  by  physician's  examination  or  by 
efinite  symptoms. 

Describe  the  various  complaints  of  the  patient  in 
le  proper  spaces :  cough,  weakness,  dyspnoea,  pain 
1  the  chest,  loss  of  flesh,  etc. 

Try  to  obtain  the  normal,  not  the  maximum  weight. 

Give  date  of  onset  of  throat  symptoms. 

State  whether  appetite  is  good,  bad,  failing,  im- 
roving. 

Indigestion,  whether  acute  or  chronic. 

165 


Constipation,  whether  recent  or  hahitual. 

Diarrhoea,  whether  occasional,  severe,  and  for  ho^ 
long. 

Sleep,  whether  normal  or  disturbed. 

State  whether  fever  is  recent,  for  how  long,  i 
marked,  or  slight,  and  time  of  day  it  occurs. 

Chills,  whether  slight  or  severe,  and  for  how  lon^ 

Night  sweats,  whether  copious,  severe,  occasiona 
or  cold. 

State  degree  of  weakness,  for  how  long,  and  i 
usually  in  afternoon. 

Inquire  as  to  severity  of  cough  during  day  or  nighi 
and  spasmodic  vomiting  after  cough. 

Give  number  of  ounces  of  expectoration  in  twentj 
four  hours  (estimated),  watery,  purulent,  or  hard  t 
raise. 

State  degree  of  dyspnoea,  whether  it  appears  o 
exertion  or  is  constant,  and  whether  recent  or  of  Ion 
standing. 

In  questioning  as  to  haemoptysis  be  sure  that  epis 
taxis  is  not  mistaken  for  haemoptysis;  give  date  o 
each  attack  and  amount  of  blood  (estimated). 

Give  location  of  any  pain  complained  of. 

It  is  not  enough  to  write  down  just  the  answe 
of  the  patient.  What  are  needed  are  facts.  N 
history  at  all  is  better  than  a  faulty  one.  Go  ove 
the  questions  again  and  again  if  necessary.  Remen 
ber  that  what  is  important  to  the  physician  ofte; 
appears  of  no  consequence  to  the  patient.  Most  im 
portaut  are  possible  sources  of  infection,  contribut 
Ing  illnesses,  and  the  earliest  symptoms  and  date  o 
failing  health. 

166 


I 


SYSTEM  OF  FILING  HISTORIES. 


^ec.  207.  All  histories,  together  with  the  later  his- 
ry  card  (Form  68  L),  throat  history  (Form  99  L), 
agram  card  (Form  211 L),  and  clinical  record 
•iputum,  blood,  urine-,  X-ray)  (Form  212  L),  are 
ed  according  to  year  and  number  in  a  special  en- 
'lope  (Form  77  L).  These  cards  are  all  of  uniform 
/e  (8  inches  by  5  inches),  and  are  of  different  colors 
as  to  be  readily  distinguished. 

The  following  system  of  filing  is  used: 

(a)  Current   cases   under  observation.     These   are 
pt  in   the   registration  room,   filed   in   four   groups 

a  week  each — i.  e.,  those  who  have  called  three 
?eks,  two  weeks  and  one  week  previously,  and  dur- 
?  the  current  week.  The  cases  are  shifted  to  the 
■rrent  week  as  they  visit  the  clinic.  In  each  group 
e  histories  are  filed  according  to  year  and  serial 
:  mber. 

(b)  All  records  of  discontinued  cases  (non-tuber- 
<lous,  discharged,  in  hospital,  not  found,  etc).  These 
i  3  filed  in  one  index  iu  the  record  room,  according  to 
\i  year  first  coming  under  observation,  and  by  num- 
!:•  under  each  year. 

(c)  Dead  cases  (obtained  from  daily  report  from 
li'ough  Office). 

\-  name  index    (Form  242  L)    is  also  kept,  the  ab- 

iation  "tbc.''  being  entered  on  each  card  as  soon 

iiut  diagnosis  is  made.     In  all  cases  referred  to 

'linic,   the  physician  or  institution  referring  the 

is  notified  by  letter  from  the  Executive  Ofllce  of 

I    result  of  the  examination. 

167 


APPLICANTS  LIVING  IN  OTHER  CLINIC 
DISTRICTS. 

Sec.  208.  All  applicants  who  live  in  other  clini 
districts  are  at  once  referred  to  the  clinic  of  thei 
district,  the  physicians'  report  (Form  158  L)  bein 
forwarded  to  the  latter.  Such  transfers  are  entered  o 
the  daily  report  to  the  Branch  Office,  forwarded  to  tl 
Borough  Office,  and  thence  to  the  Branch  Office  of  tL 
district  in  question.  The  district  nurse  visits  the  appl 
cant  at  once  and  urges  him  to  attend  the  clinic  in  h 
district.  The  histories  of  all  applicants  who  do  n( 
reside  in  the  clinic  district  are  forwarded  to  tt 
Executive  Office,  and  from  there  to  the  proper  clini 
In  Manhattan,  where  a  number  of  the  non-Depar 
ment  clinics  do  not  exchange  records,  the  histori< 
of  cases  living  in  the  districts  of  such  clinics  ai 
filed  in  one  central  file  at  Department  Headquarter 

NON-TUBERCULOUS  APPLICANTS. 

Sec.  209.  If  an  applicant  for  examination  is  appa 
ently  not  tuberculous,  a  skeleton  history  is  made  o 
by  the  nurse  and  sent  to  the  physician,  who  decid 
as  to  the  final  disposition  of  the  case. 

ROUTINE  EXAMINATIONS  OF  BAKERS,  ETC. 

Sec.  210.    The  routine  examination  by  the  Depai 
ment  of  Eiealth  of  all  employees  of  bakeries  was  i 
stituted  in  September,  1913.     Each  baker  is  referr 
by  card  (Form  274  L)  for  examination  to  the  near(^ 
clinic  of  the  Department  of  Health  and  the  result 
his  examination  is  certified  to  on  cards  (Form  119 
prepared  for  that  purpose.     No  person  who  has  al 
infectious  disease  is  permitted  to  work  in  a  bake]| 

No    person    suffering    from    active    tuberculosis 

168 


llowed  to  engage  in  occupations  Involving  liandling 
:>od  or  drinks. 


EXAMINATION   OF  APPLICANTS   FOR 
PEDDLER'S  LICENSES. 

Sec.  211.  Applicants  at  the  Bureau  of  Licenses  for 
ermission  to  peddle,  keep  stands,  or  serve  as  public 
orters,  fall  into  the  following  groups : — 

(a)  To  peddle  (with  horse  and  wagon,  push  cart  or 
asket). 

(b)  To  maintain  stands  for  the  sale  of  newspapers, 
'uit  and  soda  water,  within  the  stoop  line  of  build- 
igs. 

(c)  To  maintain  newsstands  under  the  stairs  of 
evated  and  railway  stations  and  behind  subway 
iosks. 

(d)  To  maintain  stands  for  hack  driving  and  ex- 
cess work. 

(e)  To  act  as  public  porters, 

They  are  referred  for  examination  to  the  nearest 
iiljerculosis  Clinic.  The  result  of  the  examination  is 
irtified  to  (non-department  clinics  Form  87  L;  Depart- 
lent  Clinics  Form   119  L),  and  where  the  applicant 

found  to  have  bacilliferous  sputum  the  recommenda- 
on  is  made  that  the  application  for  license  be  de- 
led. 

RECOMMENDATIONS  FOR  HOSPITAL  CARE. 

Sec.  212.  Recommendations  by  the  attending  physi- 
ans  for  the  admission  of  cases  to  hospitals  are  re- 
trred  to  the  Tuberculosis  Hospital  Admission  Bureau 
irough  the  local  Branch  Office,  by  means  of  a  special 
ird  (Form  174  L)  forwarded  in  duplicate. 

169 


Cases  for  Otisville,  Ray  Brook  and  other  sanatori 
are  also  referred  in  duplicate  on  special  history  care 
(Form  71  L)  which  are  mailed  direct  from  the  Branc 
Office  to  the  Tuberculosis  Hospital  Admission  Bureai 

SPUTUM  AND  URINE   SPECIMENS. 

Sec.  213.  Sputum  and  urine  specimens  are  place 
by  the  patients  in  the  covered  box  provided  for  thi 
purpose,  and  at  the  close  of  the  day  are  forwarde 
to  the  Diagnosis  Laboratory,  duplicate  slips,  nun 
bered  to  correspond  with  the  patient's  history  nun 
ber,  accompanying  each  [sputum,  Form  261  L ;  uriu 
Form  96  L].  All  results  of  examinations  are  entere 
on  the  clinical  record  card,  which  is  filed  with  patient 
history,  and  also  in  a  sputum  journal,  according  1 
case  number.  For  a  description  of  the  method  ( 
examination  of  sputum  at  the  Diagnosis  Laboratoi 
of  the  Department  of  Health,  see  (Monograph  No.  1 
on  "Registration  and  Sanitary  Supervision  of  Pu 
monary  Tuberculosis." 

REPORTING  OF  NEW  CASES. 

Sec.  214.  All  new  cases  of  tuberculosis  in  whic 
the  diagnosis  has  been  confirmed  by  re-examinatio 
by  a  second  physician,  or  by  tubercle  bacilli  beic 
found  in  the  sputum,  are  reported  the  followin 
morning  to  the  local  Branch  Office  on  the  specii 
blank  "Daily  Report  to  Borough  Office"  (Form  94  L 
used  for  this  purpose.  The  daily  report  of  new  casei 
deaths,  admissions  to  hospitals,  changes  of  addresi 
discharges,  etc.,  from  the  Borough  Office  is  in  tur 
submitted  daily  to  the  clinic  for  correction  of  11, 
records.     Doubtful   cases,   later  proving   tuberculoui 

170 


ire  similarly  reported.  All  reports  and  recommendd- 
ious  are  forwarded  from  the  registration  room  by 
be  Supervising  Nurse  to  the  Physician-in-charge. 

DEATHS. 

Sec.  215.  All  deaths  from  tuberculosis,  as  reported 
ally  from  the  Branch  Office,  are  looked  up  in  the 
liuic  records;  such  histories  are  filed  separately,  and 
orwarded  to  the  Borough  Office. 

PROCEDURE  IN  EXAMINATION  ROOMS. 

Sec.  21G.  In  the  examination  rooms  the  patients 
t  their  first  visit  are  weighed,  the  body  tempera- 
ure,  pulse  and  general  condition  noted  on  the  his- 
jry  card ;  a  complete  physical  examination  is  made, 
11(1  the  results  noted  on  history  card,  and  also  on 
iagram  card.  On  the  later  visit  card  a  "record  is 
lade  of  treatment  ordered  or  of  recommendations 
jY  X-ray  examination,  extra  diet  (milk  and  eggs, 
L'om  the  Auxiliary  in  Manhattan  and  the  Brooklyn 
lureau  of  Charities  in  Brooklyn),  and  admission  to 

hospital. 

SYSTEM    OF    ABBREVIATIONS. 

Sec.  217.  The  following  system  of  abbreviations 
;  used  by  the  attending  physicians  to  indicate  the 
^^lllt  of  the  physical  examination. 

Only  the  extent  of  lesion  is  shown  on  diagram  card. 

INSPECTION : 

xjuansion    Exp. 

Diminished    Exp.  

Absent    Exp.  O. 

171 


PALPATION : 

Vocal  Fremitus  V.  P. 

Increased    V.  F.  - 

Diminished    V.  F.  - 

Absent   V.  F.  < 

PERCUSSION: 

Impaired .....,, ,i , . . . ? . .  //// 

Dull - ^_ 

AUSCULTATION : 

Respiration    B. 

Harsh    R.  • 

Diminished    R.  - 

Absent    R.  ( 

Broncho    Vesicular    R.Br. 


Expiration    E. 

Prolonged  E 

High  Pitched   E 

Vocal  Resonance V.  R. 

Increased    V.  R. 

Diminished    V.  R.  - 

Absent    V.  R.  ( 

Bronchophony  Bronchop 


lialos: 


Fine  

Medium     - 

Coarse 

Friction  Sounds 


172 


CONFIRMATORY   RE-EXAMINATIONS. 

Sec.  218.  Cases  thought  to  be  tuberculous  on  first 
r  later  examination  are  at  once  referred  to  the  other 
linic  physician  on  duty  that  day  for  confirmatory 
xamination.  If  the  diagnosis  is  confirmed,  the  sec- 
nd  physician  writes  "O.  K."  and  his  initials  after 
he  original  diagnosis  on  the  history  card.  The  first 
xaminer  must  also  enter  the  stage  of  the  disease, 
ising  the  classification  adopted  by  the  National  As- 
ociation  for  the  Study  and  Prevention  of  Tubercu- 
osis.  Where  the  two  physicians  do  not  agree,  the 
■ase  is  referred  to  the  Physician-in-charge  for  final 
lecision.  All  undiagnosed  cases  which  have  attended 
he  clinic  for  a  month  or  longer  are  also  automati- 
■ally  referred  to  him  for  final  diagnosis  and  disposal. 

INSTRUCTION  OF   PATIENTS— CIRCULAR. 

Sec.  219.  The  patient  receives  thorough  instruc- 
ion  from  the  attending  physician  as  to  diet,  mode 
)f  living  and  exercise,  special  effort  being  made, 
vhere  hospital  care  is  indicated,  to  induce  the 
)atient  to  enter  an  institution.  In  addition  a  circu- 
ar  of  instruction,  "Advice  for  Patients,"  printed  in 
English  -  German  (Form  139  L) ,  English  -  Hebrew 
fForm  147  L),  and  English-Italian  (Form  155  L)  is 
supplied. 

MEDICINES. 

Sec.  220.  Medicines  are  ordered  on  prescription 
(Form  74  L)  from  the  clinic  formulary  (Form  258  L) 
iu(\  are  supplied  from  the  drug  room,  patients  being 
instructed  to  wash  empty  bottles  before  returning 
^ame.  Special  prescriptions  for  medicines  not  in  the 
formulary,  after  approval  by  the  Physician-in-charge, 

173 


are  obtained  from  the  Drug  Laboratory,  through  tt 
office  of  the  Chief  of  Division.  A  daily  record  is  kej 
of  the  number  and  kind  of  medicines  issued,  and  ( 
medicines  and  supplies  received,  on  a  monthly  loost 
leaf  sheet  (Form  132  L). 

The  weekly  requisition  for  drugs  (Form  3Y)  mm 
reach  the  Executive  Office  by  Wednesday  mornini 
The  monthly  statement  of  drugs  on  hand  (Fori 
154  L),  together  with  all  prescriptions  for  the  pr( 
ceding  month,  must  be  forwarded  by  the  fourth  of  eae 
month. 

THROAT    EXAMINATIONS. 

Sec.  221.  r^very  new  applicant  is  referred  to  th 
throat  room  for  examination  and  treatment.  A  sp( 
cial  history  card  (Form  99  L)  is  used,  on  whie 
treatment  and  later  visits  are  recorded.  Laryngolc 
gists  dispense  and  are  responsible  for  any  cocain 
issued,  sending  a  voucher  to  the  drug  room  eac. 
time. 

HOME  VISITS  BY  NURSES. 

Sec.  222.  Every  case  of  tuberculosis  attending  th 
clinic  is  visited  at  suitable  intervals  by  the  distric 
nurse.  Her  report  of  the  home  conditions  (Foru 
44  Ij)  when  forwarded  from  the  Branch  Office  is  sub 
mitted  to  the  attending  physician  for  his  informa 
tion  and  signed  by  him,  any  special  informatioi 
being  added  to  the  patient's  history  card  for  the  in 
formation  of  the  physician.  The  nurse  repeats  hei 
visits  at  least  once  every  two  months,  and  mucl 
oftener  if  necessary.  Pulse,  temperature  and  respir 
ation  are  taken  at  every  visit.  Reports  of  later  visiti 
are  given  on  the  daily  report  of  the  Branch  Offic( 
to  the  Borough  Office,  which  is  submitted  to  the  clini< 

174 


ach  day,  wbere  reports  are  entered.  Suggestions  as 
0  diet  and  general  treatment  are  given  by  the  physi- 
ian  to  the  nurse. 

DELINQUENT  CASES. 

Sec.  223.  When  patients  fail  to  return  to  the  clinic 
u  the  date  set,  a  double  return  postal  [English  (Form 
17  L)  ;  Italian  (Form  276  L)]  is  sent  them  one  week 
ater,  asking  for  reason  of  absence  and  date  of  return. 

Bach  day  a  "delinquent  case  card"  (Form  150  L) 
s  filled  out  for  every  patient  who  has  failed  to  re- 
urn  to  or  notify  the  clinic  for  a  period  of  three 
veeks.  This  is  forwarded  at  once  to  the  Branch 
)flice  for  investigation  by  the  district  nurse,  who  re- 
torts why  patient  failed  to  attend  clinic,  whether  he 
v'ill  return,  and  w^hen.  Patients  are  not  discharged 
or  non-attendance  until  a  delinquent  card  has  been 
eturned. 

STUDY  OF  CASES. 

Sec.  224.  In  connection  with  the  examination  and 
reatment  of  the  patients,  the  following  points  are 
'bserved :  Each  new  patient  is  carefully  studied,  and 
t  first  and  subsequent  visits  an  earnest  effort  is 
iiade  by  the  physician  to  gain  that  confidence  and 
0  exercise  that  moral  control  of  his  patient  necessary 
or  attaining  good  results.  To  this  end,  if  it  seems 
'Ivisable,  the  patient  is  frankly  told  the  nature  of 
li(;  disease,  the  result  of  the  sputum  examination, 
lis  weight,  and  the  general  prognosis.  This  informa- 
Joii  is,  however,  given  only  to  patients  or  to  those 
ocorapanying  them. 

'J'he  great  importance  of  proper  and  sufficient  food, 
r(;sh  air  and  hygienic  living  is  emphasized. 

175 


FINAL  DIAGNOSIS,  LATER  EXAMINATIONS. 

Sec.  225.  A  final  diagnosis  is  made  in  every  cas 
as  soon  as  possible  and  is  entered  in  the  journa 
At  each  subsequent  visit  of  the  patient,  the  bod 
temperature,  weight,  pulse,  medication  and  gener£ 
condition  are  noted  on  the  later  history  card  (Fori 
68  L).  The  date  of  the  next  visit  to  be  paid  is  als 
entered  on  the  card,  and  a  nurse  personally  uotifie 
each  patient.  A  complete  re-examination  of  the  ches 
with  entry  on  diagram  card,  is  made  at  least  one 
every  month.  Patients  are  advised  to  return  as  fr( 
quently  as  the  physician  considers  necessary,  the  ir 
terval  between  visits  being  not  longer  than  one  wee! 
All  patients  remaining  under  treatment  revisit  tb 
clinic  on  certain  days  and  hours  of  each  week,  accorc 
ing  to  the  special  sub-district  of  the  clinic  district  i 
which  they  reside.  On  that  day  and  hour  of  each  wee 
the  district  nurse  of  that  sub-district  is  on  duty  in  th 
clinic;  she  thus  gets  in  close  touch  with  the  patiem 
promoting  the  work  of  the  clinic,  and  giving  valuabl 
information  to  the  attending  physician.  When  re 
quired  to  return  for  a  special  purpose  (tuberculin  tes 
radiograph,  etc.),  patients  are  given  a  special  car 
(Form  5L).  Medical  reports  to  the  Executive  Offic 
on  the  physical  condition  of  patients  are  also  made  o 
a  special  card  (Form  87 L).  No  patient  is  refuse 
examination  and  such  medication  as  is  necessary 
those  having  no  tuberculous  lesion  are  referred  t 
general  hospitals  and  dispensaries.  If  for  any  reaso: 
the  physician  considers  that  a  tuberculosis  patien 
should  not  receive  further  treatment,  the  matter  i 
referred  to  the  Physician-ln-charge,  with  a  brie 
statement  of  facts  in  the  case.  No  patient  with  cougl 
and  expectoration  is  discharged  as  free  from  tubercu 

176 


)s!s  unless  three  negative  sputum  reports  have  been 
?ceived,  and  the  physical  signs  and  general  history 
-arrant  such  action. 

CHARITABLE   AID. 

Sec.  226.  Deserving  patients  who  are  in  need  are 
[ecommended  for  financial   assistance  by  the  attend- 

»g  physicians,  and  such  recommendations  are  for- 
i^arded  to  the  Branch  Office  and  there  submitted  to 
he  local  Clinic  Relief  Committee,  if  one  exists.  If 
,ot,  they  are  forwarded  to  the  Charity  Organization 
lociety.  Association  for  Improving  the  Condition  of 
he  Poor,  United  Hebrew  Charities,  Brooklyn  Bureau 
)f  Charities,  etc. 

CLINIC  RELIEF  COMMITTEES. 

Sec.  227.  At  each  clinic  of  the  Department  of 
lealth,  all  recommendations  for  charitable  aid  are 
■eferred  to  and  acted  upon  by  the  local  Clinic  Relief 
"ommittee,  meeting  once  a  week,  and  composed  of  the 
F'hysician-in-charge  (chairman)  and  representatives 
)f  the  Clinic  Auxiliary,  and  of  each  of  the  three 
arge  private  charitable  organizations. 

(There  is  one  committee  for  both  Bronx  Clinics 
and  none  for  the  Queens  and  Richmond  Clinics.) 

HOME  VISITS  BY  CLINIC  PHYSICIANS. 
Sec.  228.  Patients  too  feeble  to  attend  the  clinic 
are  visited  by  a  clinic  physician,  and  medical  care 
provided  pending  admission  to  a  hospital.  Undiag- 
nosed cases  refusing  to  return  to  the  clinic  and  new 
suspected  cases  of  tuberculosis  are  also  visited  by 
clinic  physicians  for  diagnosis,  all  reports  being  sub- 
mitted on  a  clinic  diagram  card  (Form  211  L).    They 

177 


may  also  be  called  on  to  examine  other  members  o 
a  consumptive  family.  Cases  are  assigned  by  th 
Physician-in-cliarge,  and  a  record  kept  in  the  clini 
journal. 

MILK   AND   EGGS. 

Sec.  229.  The  Woman's  Auxiliary  of  the  Manhat 
tan  Tuberculosis  Clinics  of  the  Department  of  Healtl 
and  the  Brooklyn  Bureau  of  Charities  distribute  on 
quart  of  milk  and  two  eggs  daily  to  each  patient  a 
long  as  required,  and  groceries  and  clothing  in  deseri/ 
ing  cases. 

RULES  FOR  ATTENDING  PHYSICIANS. 

Sec.  230.  The  attending  physicians  arrive  punct 
ually  at  10  A.  M.,  2  P.  M.  and  8  P.  M.,  and  mus 
enter  the  time  of  their  arrival  and  departure  on  th< 
regulation  time  sheets  kept  in  the  registration  room 
They  will  remain  until  all  patients,  both  men  am 
women,  have  received  attention.  When  work  is  ligh 
they  may  be  assigned  to  visit  undiagnosed  cases.  I: 
for  any  reason  a  physician  is  prevented  from  attend 
ing  his  class,  he  must  notify  the  clinic  promptly  bj 
telephone. 

Clinic  physicians  and  laryngologists  are  required 
to  devote  four  sessions  of  two  hours  each  to  the 
work  of  the  Department  of  Health  each  week.  Eacb' 
physician  can,  therefore,  devote  at  least  two  hours 
weekly  to  home  visiting,  in  addition  to  his  three  clinic 
sessions,  and  is  expected  to  make  at  least  two  home 
visits  a  week.  Should  more  than  two  hours  a  week 
be  required  for  such  visiting,  the  surplus  time  may  be' 
deducted  from  the  clinic  work.  Every  visit  made  is 
to  be  entered  on  the  back  of  the  time  sheet,  the  total 
time  required  being  noted. 

178 


In  every  case  of  tuberculosis,  institution  care  is 
'commended  on  the  history,  or  the  reason  given  for 
3t  doing  so. 

No  tuberculous  patients  are  discharged  except  by 
leir  own  request.  Previous  to  discharge,  patients 
)nsidered  to  be  cured  are  examined  and  their  dis- 
large  approved  by  the  Physician-in-charge. 

Prescriptions  show  the  date,  patient's  clinic  num- 
>r,  and  the  physician's  signature.  A  new  prescrip- 
on  must  be  written  for  each  renewal.  Each  pre- 
■ription  is  recorded  on  the  history  card  in  every 
;stance.  Prescriptions  left  at  patients'  homes  are 
»  be  written  on  the  official  blank  or  on  plain  paper, 
■"ver  on  the  physician's   private  prescription  blank. 

If  the  physician  desires  that  the  patient  should  be 
ivisited  by  the  nurse,  enter  a  hospital,  receive  chari- 
ble  aid,  be  discharged  from  treatment  or  trans- 
rred  to  other  classes,  he  states  this  fact  on  the 
story  card. 

The  system  of  signs  and  abbreviations  adopted  by 
le  Department  of  Health  is  used  in  all  cases  to  indi- 
ite  on  the  history  diagram  the  result  of  the  exami- 
ition  of  the  chest. 

All  patients  are  told  to  attend  the  classes  at  which 

le  district  nurse  of   their   sub-district   is  regularly 

i  "esent.     Patients  applying  for  emergency  treatment, 

bwever,  are  examined  and  treated  by  the  physician 

whom  they  may  be  temporarily  assigned. 

Medicines  are  supplied  only  to   tona  -fide  patients 

the  clinic.     Prescriptions  are  not,  as  a  rule,  re- 

iwed  except  for  patients  personally   attending  the 

iriic   or    on   presentation    of   their    admission   card, 

179 


by  another,  but  exceptions  are  made  for  good  reasoi 
and  at  the  discretion  of  the  attending  physician.  Whe 
the  clinic  formulary  is  not  used,  prescriptions  must  I 
approved  by  the  Physician-in-charge. 

VOLUNTEER   ATTENDING    PHYSICIANS. 

PROBATIONARY    PERIOD. 

Sec.  231.  Volunteer  Attending  Physicians  to  th 
Tuberculosis  Clinics  are  appointed  first  for  a  probi 
tionary  period  of  three  months,  during  which  perio 
they  are  required  to  comply  with  all  the  regulatior 
applying  to  salaried  employees  as  to  hours  on  dut 
per  week ;  to  submit  time  sheets  every  ten  days  an 
to  forward  notifications  of  absence  and  requests  fc 
leave  of  absence.  Efficiency  records  of  their  servic( 
are  kept,  on  which  and  on  their  length  of  service  ai 
based  recommendations  for  their  permanent  appoin 
ment. 


APPOINTMENT    AND    PROMOTION    OF    VOLUI 
TEER  ATTENDING  PHYSICIANS. 


Sec.  232.  The  appointment  and  promotion  of  Volui 
teer  Assistant  Attending  Physician  to  the  Tuberculosi 
Clinics  has  been  made  uniform  with  other  appoin 
ments  and  promotions  in  the  Department  of  Health 
i.  e.,  applicants  for  appointment,  when  approved  b 
the  Chief  of  the  Tuberculosis  Division  and  the  Dire 
tor  of  the  Bureau  of  Infectious  Diseases,  are  appointe 
by  the  Board  of  Health,  Recommendations  for  the: 
appointment  to  fill  vacancies  in  the  salaried  staff  ai 
based  on  their  efficiency  records  and  on  their  lengt 
of  service.  Such  vacancies  are  also  advertised  in  tt 
publications  of  the  Department. 


180 


CLINIC  NURSES. 
Sec.  233.  All  nurses  assist  in  preparing  clinic  sup- 
ies  when  not  otherwise  engaged,  and  all  maintain 
ueral  supervision  over  the  patients,  seeing  that  they 
e  supplied  with  sputum  pouches,  and  use  them,  that 
ey  hold  paper  napkins  before  the  mouth  when  cough-* 
g,  that  drinking  cups  are  only  used  once  and  then 
rown  into  the  receptacle  provided,  etc. 

RULES  FOR  CLINIC  NURSES. 

Sec.  234.  The  white  gowns  furnished  by  the  De- 
irtment  are  worn  while  on  duty.  Nurses  devote  as 
uch  as  is  necessary  of  the  first  hour  of  each  clinic 
ly  {i.  e.,  from  9  to  10  A.  M.,  or  1  to  2  P.  M.)  to 
eir  work  in  the  Branch  Office,  obtaining  assign- 
ents,  etc.  At  the  night  classes,  nurses  on  duty  re- 
»rt  at  7.30  P.  M. 

One  hour  is  allowed  for  lunch,  but  at  least  one 
irse  must  always  be  in  the  registration  room. 

Each  nurse  sees  that  the  supplies  and  instruments 
the  room  under  her  charge  are  in  good  order. 

Thermometers  after  use  are  wiped  with  a  pledget 
cotton  saturated  with  boracic  acid,  then  placed 
a  1  to  20  carbolic  acid  solution.     Before  use  they 

•e  washed  in  95  per  cent,  alcohol. 

All  diagnostic  instruments  are  wiped  at  the  close 
'  each  day's  session  with  a  cloth  wet  with  a  solu- 
Dn  of  1  to  100  carbolic  acid. 

During  the  noon  hour  all  the  windows  and  inside 
)ors  are  opened  for  the  airing  and  ventilation  of  the 
•oms. 

At  the  close  of  each  class,  all  histories  are  returned 
the  registration  room. 

181 


CIRCULAR    OF    INFORMATION. 

Sec.  235.  A  "Circular  of  Information  Regardli 
the  Clinics  for  the  Treatment  of  Pulmonary  Disease 
(Form  60  L)  is  issued  by  the  Department  and  di 
tributed  to  physicians  and  those  interested. 

THE  WOMEN'S  AUXILIARY  TO  THE  TUBERC 
LOSIS  CLINICS  OF  THE  DEPARTMENT 
OF  HEALTH. 

Sec.  236.  This  association  is  made  up  of  ladi 
interested  in  the  work  of  the  Manhattan  Tuberculof 
Clinics.  Separate  committees  have  been  organiz 
for  each  of  the  clinics,  together  with  a  central  coi 
mittee.     The  work  of  the  Auxiliary  includes: 

1.  The  direction  of  the  Tuberculosis  Camp  Midd 
town.  This  includes  everything  connected  with  t 
Camp,  except  medical  care  and  supervision  of  t 
patients. 

2.  Furnishing  charitable  aid  in  worthy  cases  i 
ported  by  the  Manhattan  Tuberculosis  Clinics  of  t 
Department  of  Health;  this  takes  the  form  of  gi 
ceries,  clothing,  fuel,  assistance  with  rent,  etc.  Nurs 
with  a  knowledge  of  social  service  are  detailed 
assist  the  Auxiliary  at  each  clinic. 

3.  Furnishing  outfits  to  indigent  applicants  i| 
Otisville  Sanatorium,  and  the  Preventorium. 

4.  Supplying  milk  and  eggs  as  extra  diet,  in  su' 
able  cases  from  the  clinic,  also  modified  milk  fro 
the  Babies'  Dairy,  to  the  babies  of  clinic  patients. 

5.  Co-operation  with  the  local  Clinic  Relief  Co- 
mittees. 

6.  Maintaining  and  conducting  the  Chelsea  D' 
Nursery  at  346  West  27th  Street,  for  the  children  ' 
tuberculous  parents. 

182 


rHE  ASSOCIATION  OF  TUBERCULOSIS  CLINICS. 

Sec.  237.  The  Tuberculosis  Clinics  of  the  Depart- 
nent  are  members  of  the  Association  of  Tuberculosis 
Clinics.  This  Association  is  composed  of  the  tuber- 
lulosis  clinics  which  divide  the  various  Boroughs  of 
^ew  York  City  into  districts,  all  applicants  being  re- 
ferred to  the  clinic  of  the  district  in  which  the  appli- 
■ant  lives;  patients  refusing  to  attend  those  clinics 
re  visited  by  nurses  of  the  Department  of  Health, 
md  if  in  need  of  treatment  are  notified  that  they  must 
ttend  the  clinic,  put  themselves  under  the  care  of  a 
irivate  physician,  or  else  enter  a  hospital  or  sana- 
orium.  The  children  of  those  patients  found  to  be 
uberculous  are  also  examined  in  these  clinics.  In 
Jrooklyn,  The  Bronx,  Queens  and  Richmond  the  only 
uberculosis  clinics  are  those  maintained  by  the  De- 
artment  of  Health. 

The  Department  issues  a  circular  of  information  re- 
arding  the  Association  of  Tuberculosis  Clinics  (Form 
L)  ;  also  reference  cards  used  for  transferring  cases 
Form  141  L)  and  folders  for  use  by  charitable  or- 
anizations  for  referring  cases  to  the  clinics  (Form 
8L). 

Every  clinic  submits  a  monthly  report  to  the  Asso- 
iation.  For  complete  list  of  names,  addresses  and 
ours  of  clinics,  see  Directory  Sec.  2. 

DIVISION  OF  TYPHOID  FEVER. 

Sec.  238.  The  Division  of  Typhoid  Fever  is  charged 
ith  the  registration  and  sanitary  supervision  of  all 
ises  of  typhoid  fever  occurring  in  New  York  City. 

183 


CHIEF   OF    DIVISION. 

Sec.  239.  The  Chief  of  Division  exercises  genera 
supervision  over  all  matters  pertaining  to  the  work  o: 
his  Division  throughout  the  City. 

OFFICE  OF  CHIEF  OF  DIVISION. 

Sec.  240.  In  the  office  of  the  Chief  of  Division  th. 
accuracy  of  statistical  figures  is  supervised  and  tht 
results  of  the  various  activities  in  the  Borough  am 
Branch  Offices  are  carefully  tabulated  for  the  purposi 
of  bringing  out  the  essential  factors  in  the  causatioj 
and  control  of  infection. 

TYPHOID  CHARTS  AND  TABULATIONS. 

Sec.  241.  A  chart  is  kept  showing  the  number  o 
cases  reported  daily  and  weekly  from  each  Borougl 
and  from  each  ward  therein,  the  corresponding  figure 
for  the  year  previous,  and  the  averages  for  five  year 
by  wards  and  boroughs. 

MAPPING   OF   CASES. 

Sec.  242.  Each  case  reported  is  at  once  plotted  o 
a  large  compo-board  map  of  the  Borough  by  colore 
tacks  indicating  the  possible  sources  of  infectioi 
as  follows : 

Red — Out  of  city  during  the  incubation  period. 

Yellow — History  of  exposure  to  typhoid  fever. 

Blue — ^All  other  sources  of  infection. 

Two  such  maps  are  kept  for  each  Borough,  on 
showing  all  cases  for  the  calendar  year  and  the  otht 
current  cases  only.  A  map  showing  business  addres 
of  each  case  is  also  kept. 


184 


I 


There  are  also  kept:  (a)  a  tabulation  for  each 
Borough  showing  the  most  important  features  related 
:n  the  histories. 

(b)  A  chart  for  each  Borough  showing  the  num- 
ber of  cases  using  milk  from  the  various  wholesale 
railk  dealers.  This  is  so  arranged  as  to  show  the  age, 
mset  and  locality   (district)   for  each  case. 

(c)  A  chart  showing  the  number  of  cases  using  milk 
'rom  the  various  country  creameries. 

Any  localized  or  general  increased  prevalence  is  thus 
speedily  brought  into  prominence,  its  cause  is  sought 
"or,  and  reports  and  recommendations  regarding  any 
leedful  action  by  the  co-ordinate  branches  of  the  De- 
)artment,  or  if  necessary  by  other  City  Departments 
ire  made  to  the  Director. 

A  daybook  is  kept  containing  the  name  and  address 
j)f  each  case  reported,  the  date  of  assignment  to  the 
Inspector  and  the  date  the  history  is  received  in  tbe 
)ffice  of  the  Division  of  Typhoid  Fever. 

A  record  is  kept  in  a  "suspected  case"  book  of  cases 
>f  typhoid  fever  in  which  there  is  a  positive  diazo 
'eaction  in  the  urine  only,  and  of  those  in  which 
he  Widal  test  is  negative,  but  a  positive  clinical  diag- 
losis  has  been  made  by  the  attending  physician.  If 
.he  diagnosis  is  not  confirmed  by  a  postal  from  the 
)hysician  or  positive  blood  specimen,  within  one  week 
)f  the  receipt  of  the  original  laboratory  specimen,  the 
ittending  physician  is  communicated  with  by  telephone 
o  obtain  his  opinion  as  to  the  disposal  of  the  case  as 
rue  or  false. 

A  journal  is  kept  of  all  immunizations  against 
yphoid  fever  together  with  the  number  exposed  and 
mmunized  for  each  case. 

185 


The  typhoid  fever  histories  are  forwarded  after  the 
first  inspection,  directly  to  the  office  of  the  Division 
of  Typhoid  Fever  by  the  Branch  Office.  Six  weeks 
later  the  final  history  of  the  case  is  obtained  by  let- 
ter, the  physician  or  hospital  being  requested  to  fur- 
nish information  on  a  special  blank  (Form  67  L)  as 
to  subsequent  course  and  outcome  of  the  case.  Should 
no  reply  be  received  within  one  week,  the  case  is  re- 
assigned to  an  inspector,  who  visits  the  attending 
physician  or  the  hospital  (with  the  consent  of  the 
attending  physician)  and  ascertains  whether  there 
was:  (1)  recovery  or  death;  (2)  relapse;  (3)  perfora- 
tion; (4)  hemorrhage;  (5)  whether  sequelae  devel- 
oped, and  (6)  the  duration  of  the  illness  in  week- 
periods  based  on  the  date  of  onset,  and  date  tempera- 
ture reached  normal.  A  letter  (Form  181  L)  is  sent 
to  all  physicians  reporting  cases  more  than  two  weeks 
after  the  onset  of  the  disease,  requesting  an  explana- 
tion of  the  delay.  When  all  the  above  data  regarding 
a  terminated  case  are  received  they  are  duly  enterec 
on  the  history  card,  which  is  then  sent  to  the  Borougl 
Office  for  the  terminated  case  file. 

The  office  of  the  Division  of  Typhoid  Fever  makes 
the  following  reports:  (a)  A  weekly  report  showing 
the  average  daily  time  of  inspectors  in  the  field,  anc 
the  number  of  visits  and  immunizations  performed 
(Form  171 L)  ;  (b)  a  weekly  report  in  duplicate  show 
ing  the  number  of  typhoid  fever  cases  in  each  Bor 
ough  and  in  the  City,  as  compared  with  corresponding 
periods  for  the  previous  year  and  the  average  for  fiv( 
years;  (c)  a  weekly  report  in  triplicate  showing  th< 
cases  in  each  Borough  by  districts  (Form  183  L)  ;  (d^ 
a  monthly  report  showing  the  average  daily  time  fo] 
each  inspector;  and  (e)   annual  and  semi-annual  re 

186 


)rts  analyzing  and  summarizing  the  work  performed, 
ith  a  brief  but  adequate  discussion  of  all  matters  of 
►ecial  Interest. 

rPHOlD    FEVER   NOTIFICATION    AND   REGIS- 
TRATION. 

Sec.  243.  Notification :  The  procedure  for  notifica- 
on  has  already  been  described  (Sees.  38,  39). 

REGISTRATION. 

BOROUGH  OFFICE. 

All  cases  are  reported  to  the  respective  Borough 
ffices,  there  compared  with  the  current  envelope  case 
es  of  infectious  diseases  and  then  telephoned  daily 
;  8.30  A.  M.  to  the  proper  Branch  Offices,  where  they 
•e  assigned  to  the  inspectors,  and  nurses  for  inspec- 
on  and  sanitary  supervision.  The  original  postal 
id  laboratory  reports  (Forms  7  J,  126  L,  11  L)  are 
led  in  envelopes  (Form  —  L)  in  the  current  case 
le  and  the  case  is  entered  in  the  house  file.  When 
e  cases  are  terminated,  and  the  histories  are  returned 
•om  the  Office  of  the  Division  of  Typhoid  Fever  they 
re  placed  in  the  envelopes  containing  the  original 
sports  and  refiled  in  the  terminated  case  file,  thus 
)mpleting  the  record  for  each  case. 
Each  Borough  Office  submits  and  records  the  fol- 
wing  reports:  (a)  Daily  telephone  report  to  the 
entral  Executive  Office  by  9.15  A.  M. ;  (b)  weekly 
immary  of  the  number  of  cases  of  typhoid  fever; 

c)  daily  report  of  name,  age  and  address  of  all  new 
isGs  (dead  and  living)  of  typhoid  fever  reported  to 
le  Manhattan  Borough  Office  for  printed  school  list; 

d)  monthly  report  showing  correct  number  of  cases 

187 


and  deaths  of  typhoid  fever,  to  the  Executive  OfBc 
[Note. — The  monthly  records  are  held  open  until  tt 
8th  of  the  following  month  to  allow  for  the  dedu< 
tion  for  "no  cases,"  all  of  which  are  deducted  froi 
the  figures  of  the  month  in  which  they  were  original! 
reported.  All  "no  case"  reports  received  after  tb 
expiration  of  the  month  are  reported  as  of  the  las 
day  of  the  expired  month.]  A  duplicate  report  car 
is  made  out  and  forwarded  daily  to  the  Typhoid  Divif 
ion  for  each  case  of  typhoid  fever  reported,  whethe 
by  postal,  positive  blood  specimen,  telephone  complaii 
or  otherwise. 

All  reports  of  cases  are  acknowledged  by  postal. 

BRANCH   OFFICES. 

Sec.  244.  These  offices  receive  their  new  cases  dail 
at  8.30  A.  M.  and  assign  them  to  the  medical  inspec 
tor,  who  calls  each  morning.  His  daily  report  (se 
Sec.  246),  when  completed,  is  forwarded  direct  to  th 
Office  of  Division  of  Typhoid  Fever.  The  typhoid  in 
spector  reports,  and  is  directly  responsible  to  the  Chiel 
Division  of  Typhoid  Fever. 

A  history  card  (Form  184  L)  is  made  out  for  eacl 
case.  On  completion  of  the  investigation,  it  is  re 
turned  to  the  Branch  Office,  where  it  is  scrutinize( 
for:— 

(a)  Non-observance  of  precautions.  Such  cases  ari 
then  visited  by  a  nurse  to  see  whether  precautioni 
as  outlined  on  hanging  card  have  been  instituted  sine 
the  inspector's  visit.  If  these  measures  are  in  force 
she  will  revisit  weekly  to  insure  their  continuance, 
precautions  have  not  been  instituted,  she  will  repea 
the  instructions  and  revisit  at  an  early  date.  Con 
tinned  negligence  will  then  be  reported  by  telephon 

188 


3  the  Typhoid  Office  by  the  Physician-in-charge  of  the 
iranch  Office  followed  by  a  written  report  (Form  3  L). 

Revisits  are  assigned  by  means  of  the  Branch  Office 
illy  file,  a  subsequent  history  card  (Form  267  L) 
eing  made  out  by  the  nurse  and  forwarded  to  the 
ffiee  of  the  Division  of  Typhoid  Fever  on  termina- 
ion  of  the  case. 

(b)  For  cases  using  milk  purchased  from  stores; 
ach  cases  are  immediately  telephoned  to  the  Officer- 
i-charge  of  the  Sanitary  Squad  of  Police  in  the  Bor- 
ugh  for  investigation,  giving  name  and  address,  date 
f  onset  and  name  and  address  of  milk  stores. 

The  history  cards  (Form  184  L)  should  be  for- 
'^arded  daily  to  the  office  of  the  Division  of  Typhoid 
'ever. 

INVESTIGATION  OF  MILK  STORES. 
Sec.  245.  These  are  investigated  by  sanitary  patrol- 
|ien  who  report  on  milk  history  card  (Form  252  L), 
le  condition  of  the  stores  and  the  source  of  the  milk 
apply  in  the  city  and  in  the  country  as  shown  by 
ae  milk  tags  kept  on  file  in  each  store.  These  re- 
orts  Ire  forwarded  direct  to  the  Office  of  the  Division 
f  TyiDhoid  Fever.* 

Any  unsanitary  condition  or  violation  of  regula- 
ions  is  included  in  the  report  which  is  made  out  in 
uplicate,  and  promptly  forwarded  to  the  Division 
►ffice.  One  copy  is  immediately  delivered  to  the 
lureau   of   Food  Inspection. 

INVESTIGATION  OF  CASES  BY  TYPHOID 
INSPECTOR. 

Sec.  246.  The  inspector  visits  the  homes  of  patients, 
icluding  those  in  hospitals   (with  the  consent  of  the 

189 


attending  physician),  and  obtains  all  required  informs 
tion.  He  investigates  the  milk  supply,  states  specil 
cally  whether  the  milk  was  bottled  or  loose,  whethi 
purchased  from  a  wagon  or  store  and  gives  the  nan 
and  address  of  the  dealer.  (Whenever  the  inspect( 
finds  two  or  more  cases  that  have  purchased  mil 
from  the  same  store,  he  immediately  notifies  the  ofla< 
of  the  Division  of  Typhoid  Fever  by  telephone.)  1 
distributes  hanging  card  of  instruction  (Forms  178 
136  L,  or  198  L.) 

Whenever  proper  precautions  are  not  being  observe 
the  inspector  makes  a  special  report  (Form  3L)  gi 
ing  particulars  and  making  recommendations.  If  tl 
necessary  precautions  cannot  be  observed,  or  are  wi 
fully  disregarded,  the  case  may  be  removed  to  ho 
pital,  in  accordance  with  the  Sanitary  Code  (s( 
Sec.  4  H).  If  the  patient  is  ill  at  home,  the  inspe 
tor  makes  certain  that  all  precautions  against  tl 
spread  of  the  disease  are  being  observed,  gives  verb; 
instructions  where  necessary,  and  in  any  event  leav 
a  copy  of  the  hanging  instruction  card,  printed 
English,  Italian,  German  and  Yiddish,  entitled  "Ho 
to  Avoid  the  Contraction  and  to  Prevent  the  Spres 
of  Typhoid  Fever."     (Forms  178  L,  136  L  or  198  L 

Whenever  two  or  more  cases  are  reported  in  tl 
same  family  or  home,  the  inspector  makes  a  simili 
report,  showing  the  connection,  if  any,  between  tl 
cases.  Inspector's  complaints  as  to  unsanitary  cond 
tions  are  forwarded  to  the  Division  of  Inspectioi 
for  further  action.  If  flies  are  numerous  on  the  prei 
ises,  the  existence  of  a  stable  in  the  immediate  vici 
ity  is  sought  for.  If  found,  inspection  of  the  stab 
for  possible  violations  of  the  provisions  of  the  Sar 

190 


•y  Code  dealing  with  the  disposal  of  manure  is 
commended,  and  verbal  and  written  instructions 
orm  53  A)  given  regarding  the  danger  of  the  spread 
(  the  disease  by  flies.  The  histories  are  returned 
the  inspector  to  the  Branch  Office  the  following 
)rning. 

ANTI-TYPHOID  IMMUNIZATION. 

Sec.  247.  The  typhoid  inspectors,  upon  request  and 
th  the  approval  of  the  attending  physician,  perform 
ti-typhoid  immunization.  Applicants  for  immuniza- 
in  having  no  attending  physician  may  have  it  done 
the  Headquarters  of  the  Department  and  at  general 
ipensaries.  The  culture  is  furnished  free  to  physi- 
mg  and  dispensaries.  Requests  are  received  by  tele- 
one  or  letter.  The  culture  used  is  a  suspension  of 
phoid  bacilli  of  weakened  virulence,  killed  by  heat. 
iree  inoculations  at  intervals  of  from  seven  to  ten 
ys  are  given,  the  first  dose  being  500,000,000  killed 
cilli  and  the  two  later  doses  1,000,000,000  killed 
^cilli.  For  persons  employed  in  business,  successive 
Uturdays  are  convenient  times.  The  inoculations  are 
ven  with  a  hypodermic  syringe,  the  injections  being 
a  fie  at  about  the  insertion  of  the  deltoid  muscle.  If 
e  injection  is  given  at  4  P.  M.,  the  reaction, 
any,  will  occur  at  bedtime.  Careful  antiseptic  pre- 
utions  must  be  observed.  The  probability  of  the 
currence  of  a  reaction  and  its  nature  should  be 
plained  to  the  patient.  The  injection  causes  some 
lii),  which  quickly  subsides.  After  a  few  hours  a 
d,  tender  oedematous  area,  several  inches  in  diam- 
(tv,  develops  at  the  site  of  injection.  There  may  also 
;  headache,  malaise  and  fever.    But  neither  the  local 

191 


nor  general  reaction  should  cause  alarm.    There  is 
relation    between    the    fever    and    reaction,    and    t 
amount  of  immunity  conferred.    Anti-typhoid  immu 
zation  should  only  be  performed  in  healthy  subjeci, 
who  have  previously  undergone  a  thorough  physi(* 
examination. 

No  person  having  or  suspected  of  having  tuberculoi 
in  any  form,  should  be  immunized. 

The  inspectors  offer  immunization  to  all  membe| 
of  every  family  in  which  a  case  of  typhoid  fever  (f 
curs,  subject  to  the  approval  of  the  attending  phyij, 
clan.  ' 

Placards  (Form  262  L)  recommending  anti-typhoi: 
immunization  are  distributed  to  dispensaries  for  t\i 
information   of  the  public.  i 

The  Research  Laboratory  supplies  the  necessaif, 
three  doses  of  culture  either  in  individual  vials,  or  1^ 
10  c.c.  vials.  The  inspector  forwards  a  report  of  ea([i 
case  immunized  (Form  245 L)  immediately  after  tlj: 
third  inoculation.  A  circular  of  information  (Fori 
250  L)   is  issued  and  distributed.  [ 

A  circular  of  condensed  information,  printed  in  foiif 
languages,  for  "the  man  in  the  street,"  is  also  diij 
tributed  (Form  281  L.)  \\ 

SPECIAL  INSTRUCTIONS  FOR  TYPHOID 
INSPECTORS. 

Sec.  248.     The  day  the  patient  went  to  bed  Is  li| 
be  considered  as  date  of  onset.    In  very  mild  or  ambil 
latory   cases,    the    inspector    will    use   his    judgmenl 
The  date  physician  was  called  must  be  given  and  al6 
date  prodromal  symptoms  were  first  noticed.    In  flmj 

192 


spections,  the  date  temperature  reached  normal  must 

given. 

If  the  disease  was  not  contracted  on  the  premises, 
e  previous  address  is  to  be  given. 
Full  details,  including  dates  of  onset,  are  to  be 
ren  of  other  cases  in  family  or  elsewhere,  where 
I  ere  is  likelihood  of  infection  by  contact. 
Any  one  who  regularly  takes  raw  milk  as  a  bever- 
;e,  if  only  one  or  two  glasses  a  week,  is  to  be  con- 
iered  as  an  "Habitual  milk  drinker,"  but  the  source 

milk  supply  is  to  be  given  in  every  case  regardless 

habits  of  patient. 
Inclusive  dates  when  patient  was  out  of  town  are  to 

given.    If  patient  was  away  for  only  a  day  or  part 

a  day,  that  fact  is  to  be  plainly  stated. 
Special  care  must  be  taken  in  obtaining  data  as  to 
ciipation.     A  general  term  such  as  clerk  must  not 
•  accepted. 

DISINFECTION. 

Section  249.  For  regulations  governing  disinfection 
cases  of  typhoid  fever,  see  Sec.  96. 

QUARANTINE.      ' 

Sec.  250.  The  regulations  governing  quarantine 
cases  of  typhoid  fever  in  the  rear  of  stores,  among 

'Od   handlers    and    in    the    family   of    a    janitor   or 

ijieilntendent  are  the  same  as  obtain  in  other  infec- 

iiis  diseases.     No  convalescent,  whose  business  has 

(V)  with  food  products,  may  return  to  work,  until 

..iiiiination  of  stools  and  urine  show  typhoid  bacilli 

■  1)0  no  longer  present. 

193 


DIVISION  OF  NURSING. 

SUPERINTENDENT  OF  NURSES. 

Sec.  2.51.  The  Superintendent  of  Nurses  has  chai 
of  all  nurses  in  the  Bureau  of  Infectious  Diseas 
She  is  responsible  for  their  punctuality  and  atte: 
ance,  reporting  all  absences  and  returns  to  du 
making  all  assignments  and  details.  She  submits  1 
following  report: — 

Each  Monday  a  weekly  report  to  the  Execut 
Office  of  the  work  of  the  district  nurses  for  the  prec< 
ing  week   (Form  142  L). 

A  daily  telephone  report  to  the  Executive  Office 
all  absences  from  and  returns  to  duty. 

A  monthly  report  of  the  total  number  of  hours 
duty  of  each  nurse. 

She  maintains  a  loose-leaf  weekly  record  of  i 
work  of  every  district  nurse  (Form  98  L). 

She  also  submits  an  annual  report  of  the  wo 
under  her  charge  to  the  Chief  of  Division,  tak 
inventories  of  her  stock  of  blanks  at  stated  Interva 
and  keeps  a  diary  of  current  events. 

She  holds  a  weekly  conference  with  the  Supervisii 
Nurses  at  which  all  new  procedures  are  discuss© 
new  orders  transmitted,  etc. 

SUPERVISING  NURSES. 
Sec.  252.  In  each  district  of  each  Borough  oi 
nurse  is  detailed  as  Supervising  Nurse.  She  is  und 
the  immediate  direction  of  the  Physician-in-chari 
of  the  district,  and  is  also  responsible  to  the  Superi 
tendent  of  Nurses.  She  has  general  supervision  i 
the  work  of  all  nurses  detailed  to  the  district  ax 

194 


;linic.  She  submits  a  daily  report  (Form  259  L)  to 
he  Superintendent  of  Nurses.  Her  duties  are  to  trans- 
nit  orders ;  to  make  visits  with  and  instruct  new  and 
ess  competent  district  nurses ;  to  investigate  daily 
*-eports  of  district  nurses  and  voluntary  renovations 
■•eported  by  them  ;  to  visit  cases  under  observation,  and 
f-eport  as  to  condition;  to  hold  weekly  conferences 
Vith  her  nurses,  and  discuss  various  topics  connected 
vith  the  work;  to  supply  nurses  with  cards,  blanks, 
!;tc. 

*         REGISTRATION  AND  CLINIC  NURSES. 

Sec.  253.    Registration  nurses  in  Branch  Offices  are 

•esponsible  to  the  Supervising  Nurses  for  the  accuracy 
md  completeness  of  all  reports  and  files  located  in 
':heir  district  unit. 

The  nurse  in  charge  of  the  Clinic  is  responsible  to 
he  Supervising  Nurse  for  the  accuracy  and  complete- 
ness of  the  records  and  files  of  all  cases  of  pulmonary 
'uberculosis  cared  for  by  the  clinic. 

j  DISTRICT  NURSES. 

I  Sec.  254.  The  duties  of  the  district  nurses  are  di- 
|7ided  into  home  visiting  in  cases  of  tuberculosis,  scar- 
et  fever,  measles,  diphtheria,  cerebro-spinal  menin- 
ritis,  acute  poliomyelitis,  whooping  cough,  typhoid 
ifever,  and  also  tuberculosis  clinic  work.  In  the  clinics 
fhe  nurses  receive  patients  and  prepare  them  for  phy- 
sical examination  by  the  physician ;  take  temperature, 
|iulse,  respiration,  weight  and  height,  supply  patient 
kvith  literature  in  their  own  language  and  instruct 
jthem  in  the  necessary  sanitary  precautions  which  they 
Should  observe. 

105 


The  district  work  consists  in  the  sanitary  supe 
vision  of  patients  suffering  from  infectious  diseas( 
and  in  the  instruction  of  the  patients  and  their  fani 
lies  in  methods  of  prevention  of  disease,  and  of  efficiei 
isolation,  disinfection,  etc.  Plans  for  social  bette 
ment  frequently  originate  from  these  home  visits. 

DISTRICT  NURSES'   OUTFIT. 

Sec.  255.  When  on  duty  in  her  district  every  nurs 
carries  with  her : 

Clinical  thermometer. 

Watch  with  second  hand. 

Fountain  pen. 

History  cards   (Forms  44 L;  184 L  and  20  J). 

Cards  for  referring  patients  to  clinic  (Form  141  L 

Circulars  and  hanging  cards  for  information  r 
garding  infectious  and  contagious  diseases  (see  Sec 
4  A,  4  B  and  4  C  for  list). 

Sputum  bags  and  paper  napliins. 

Blue  clinic  information  cards   (Form  149  L). 

Sputum  bottles. 

Notification  postal  cards    (Form  5 J). 

School  exclusion  and  re-admission  cards  (Forn 
14  J  and  7  J). 

School  exclusion  report  to  Bureau  of  Child  Hygien 
(Form  151J). 

Placards  (Forms  113  L ;  44  J ;  47  J  and  120  J) . 
Fumigation  cards   (Forms  232  L  and  94  J). 
Pland  Book  of  Bureau   (Form  202  L). 

Each  nurse  should  also  have  a  supply  of : — 
Daily  report  cards    (Form  259  L)    or  time  record 
(Form  23  A). 

196 


Renovation  orders  (Form  48  L). 

Notification  of  absence   blanks    (Form  210). 

Reserve  stock  of  various  cards  and  printed  forma 
5ed. 

All  above  supplies  to  be  obtained  from  ber  Super- 
sing  Nurse. 

GENERAL  DUTIES  OF  DISTRICT  NURSES. 

Sec.  25G.  All  district  nurses  should  thoroughly  fa- 
iliarize  themselves  vrith  all  sections  of  the  Hand- 
lok  of  Bureau  of  Infectious  Diseases  (Form  202  L), 
tiich  pertain  to  their  work.  They  should  also  be 
miliar  with  the  system  of  registration  employed 
the  Branch  Offices  and  Clinics. 

Every  district  nurse  is  expected  to  be  on  duty  at 
ist  six  hours  daily,  exclusive  of  one  hour  for  lunch- 
in    (Saturdays,    three   hours    daily).     The    Depart- 
ijnt  badge  is  to  be  worn  when  on  duty. 
Nurses  must  wear  suitable  clothing. 

NURSES'  DAILY  REPORT. 

Sec.  257.  Every  nurse  not  on  exclusive  clinic  or 
(jice  duty  in  the  Branch  Ofiice,  submits  a  daily  report 
I  her    work    for    the   preceding   twenty-four   hours 

'orm  259  L).  This  report  gives  date,  name  and 
•strict  of  nurse,  total  number  of  new  visits,  revisits, 
*3  name  and  address  of  each  patient  visited  and  the 
lur  when  nurse  reached  the  premises.  On  the  re- 
Tse  of  the  card  is  given  a  summary  of  the  day's 
^>rk,  and  the  total  number  of  hours  on  duty  sub- 
(/ided  into  (1)  on  district,  (2)  at  clinic,  and  (3) 
'  Branch  Office.  It  is  made  out  in  advance  each 
inning,  every  assignment  and  its  nature  being  en- 

197 


! 


tered  thereon,  aud  is  left  at  the  Branch  Office.    Tl 
next  morning  the  hour  of  arrival  at  each  address 
entered.     The  report  card  is  then  forwarded  to  tl 
office  of  the  Superintendent  of  Nurses.     There  it 
filed  with  the  other  daily  reports  of  that  individu 
nurse  for  the  current  week. 

NURSES'  WEEKLY  RECORD. 

Sec.  258.  At  the  close  of  each  week,  the  tota 
of  the  various  items  in  the  summary  on  the  daily  i 
ports  are  entered  on  a  weekly  record  sheet  (For 
98  L),  in  the  office  of  the  Superintendent  of  Nurs< 
A  separate  sheet  is  kept  for  each  district  nurse,  ai 
It  shows  at  a  glance  the  amount  and  kind  of  wo 
being  done  by  each  nurse.  Each  sheet  covers  a  peri 
of  fifty- two  weeks. 

DIVISION  OF  VENEREAL  AND  VETERINARY 
DISEASES. 

Sec.  2,59.  The  Division  of  Venereal  and  Veterina 
Diseases  is  charged  with  the  registration  and  sanita 
supervision  of  syphilis  and  gonorrhoea,  conducti 
Diagnostic  Clinics  for  these  diseases:  the  sanita 
supervision  of  glanders,  rabies  and  other  infectio 
diseases  in  animals ;  it  conducts  Anti-rabic  Clinics  i 
the  administration  of  anti-rabic  treatment;  and  a) 
conducts  the  Serological  Laboratory. 

CHIEF  OF  DIVISION. 
Sec.  260.  The  Chief  of  Division  exercises  gene] 
supervision  over  all  matters  pertaining  to  the  wc 
of  his  division  throughout  the  city.  He  submits 
weekly  report  (Form  254  L)  of  the  work  of  the  Di 
sion. 


Ids 


I 


VENEREAL  DISEASES. 

Sec.  2G1.  On  February  20,  1912,  the  Board  of 
lealth  of  the  Department  of  Health  of  New  York 
yity  adopted  the  following  resolutions : 

On  and  after  May  1,  1912,  the  superintendents  or 
ther  officers  in  charge  of  all  public  institutions  such 
.8  hospitals,  dispensaries,  clinics,  homes,  asylums, 
haritable  and  correctional  institutions,  including  all 
Qstitutions  which  are  supported  in  whole  or  in  part 
y  voluntary  contributions,  are  required  to  report 
romptly  the  name,  sex,  age,  nationality,  race,  marital 
tate  and  address  of  every  patient  under  observation 
buffering  from  syphilis,  in  every  stage ;  chancroid,  or 
'onorrhoeal  infection  of  every  kind  (including  gonor- 
hoeal  arthritis),  stating  the  name,  character,  stage 
nd  duration  of  the  infection,  and  the  date  and  source 
f  contraction  of  the  infection,  if  obtainable. 

All  physicians  are  requested  to  furnish  similar  in- 
ijrmation  concerning  private  patients  under  their  care, 
xcepting  that  the  name  and  address  of  the  patient 
eed  not  be  reported.  Cases  of  venereal  disease  are 
ntered  in  the  Journal  of  Infectious  Diseases   (Form 

LL),  which  is  furnished  to  every  institution  (see 
ec.  122)  ;  at  stated  intervals  an  institution  inspector 
alls  and  copies  the  information  on  report  cards 
Form  191 L),  which  are  forwarded  to  the  Division 
f  Venereal  Diseases.  All  physicians  in  New  York 
ity  have  been  requested  by  letter,  to  report  their 
ises  of  venereal  disease,  a  report  card  accompanying 
ich  letter. 

REGISTRATION. 

Sec.  262.  The  reports  of  venereal  diseases  are  filed 
I  a  special  envelope   (Form  168  L)   and  kept  under 

199 


lock  and  key.  The  institution  reports  are  filed  alpha- 
betically according  to  the  name  of  the  patient.  The 
cases  reported  by  the  private  phj'^sicians  are  givec 
a  case  number  for  identification  purposes,  by  which 
they  are  filed.  The  receipt  of  such  cases  is  acknowl 
edged  (Form  51  L),  the  physician  being  given  th( 
case  number  for  future  reference.  A  daily  journal 
is  kept  of  cases  of  venereal  disease  reported  by  physi 
cians  and  institutions. 

INSPECTION  OF  CASES. 

Sec.  263.  All  complaints  regarding  cases  of  venerea 
diseases  are  immediately  investigated  by  an  inspec 
tor  of  the  Department,  who  submits  a  written  repor 
(Form  3L).  No  further  action  is  taken  in  case; 
found  to  be  under  the  care  of  private  physicians  o 
regularly  attending  dispensaries.  Cases  under  n< 
medical  supervision  are  advised  by  the  inspector  t 
attend  the  Diagnostic  Clinics  of  the  Department  o 
Health.  Here,  according  to  their  circumstances,  the 
are  sent  to  dispensaries  or  given  lists  of  private  phj 
sicians  living  in  the  neighborhood  of  their  home,  froi 
whom  to  receive  treatment. 


MEDICAL  ADVISER. 

Sec.  264.    The  co-operation  of  the  Bureau  of  Socif 

Hygiene  has  made  it  possible  to  appoint  a  Medici 
Adviser  as  well  as  to  conduct  a  Serological  Laborator; 
The  Medical  Adviser  sees  only  those  patients  wb 
having  no  physician  (notices  to  this  effect  being  sei 
to  physicians)  (Form  169  L),  come  to  the  Departmei  f 
of  Health  for  advice.  Under  no  circumstances  does  I 
see  or  interview  patients  recommended  by  physiciai 
to  the  Department  for  the  purpose  of  having  Wasse 

200 


I 


nann  or  complement  fixation  tests  made,  unless  the 
jlij^sicians  sending  the  patients,  specifically  ask  that 
)atients  be  advised,  or  directed  to  clinics,  etc. 

If  patients  who  have  no  physicians  come  to  the  De- 
3artmeut,  these  patients  are  given  lists  of  private 
Dhysicians  or  sent  to  approved  Clinics  according  to 
heir  circumstances.  [Note. — Clinics  on  the  "approved 
isf  must  come  up  to  standards  set  by  the  Department 
)f  Health.  Clinics  desiring  to  be  listed  are  carefully 
nvestigated  before  approval  is  given.] 

The  Medical  Adviser  acts  as  a  clearing  house  for 
oatients  having  venereal  diseases.  Under  no  circum- 
Hances  is  any  treatment  given.  He  advises  patients 
3n  sex  subjects  and  informs  them  where  to  obtain  sex 
literature  and  the  cost  thereof.  Patients  are  also 
?iven  leaflets  of  advice  [(Syphilis,  Form  224  L; 
Gonorrhoea,  Form  223  L)  and  a  Circular  of  Informa- 
;ion  Regarding  Venereal  Diseases  (Form  —  L.)] 

DIAGNOSTIC   CLINICS   FOR   VENEREAL 
DISEASES. 

Sec.  265.  Diagnostic  Clinics  for  venereal  diseases 
ire  held  in  Manhattan  and  Brooklyn.  For  addresses 
md  hours  see  Directory  (Sec.  2). 

At  each  clinic  there  is  a  physician,  a  nurse  and  a 
elerk.  Patients  are  referred  to  these  clinics  for  the 
Wassermann  test  for  syphilis  and  the  complement 
fixation  test  for  gonorrhoea.  Patients  may  also  be 
referred  to  the  Manhattan  Day  Clinic  for  examina- 
tion of  freshly  prepared  specimens  for  the  treponema 
pallidum.  Only  those  patients  who  bring  written  re- 
ijuests  from  physicians  or  clinics  are  received  for  ex- 

201 


amination,  and  reports  of  the  results  of  tests  are  sent 
only  to  the  physicians  referring  the  cases,  and  by  mail 
only.  All  si^ecimens  sent  to  the  Serological  Laboratory 
are  entered  iu  a  daily  loose-leaf  journal  (Form  76  L) 

SEROLOGICAL  LABORATORY. 

Sec.  266.  A  Serological  Laboratory  is  maintained 
at  Department  Headquarters,  149  Centre  Street,  Man- 
hattan. The  Laboratory  consists  of  three  examining 
rooms — a  culture  room,  a  sterilizing  room  and  a  room 
for  the  preparation  of  outfits  for  collecting  specimens 

The  Laboratory  is  open  from  9  A.  M.  to  5  P.  M, 
daily,  Sundays  and  holidays  excepted. 

In  the  Serological  Laboratory  are  made,  free  ot 
charge,  the  following  examinations  for  physicians  and 
veterinarians:  (a)  the  Wassermann  test  for  syphilis : 
(b)  the  examination  of  smears  for  the  presence  ol 
gonococci ;  (c)  the  complement  fixation  test  for  gon- 
orrheal infection;  (d)  the  examination  of  freshly 
prepared  preparations  from  the  active  lesions,  for  the 
treponema  pallidum;  (e)  the  complement  fixatior 
test  for  glanders  in  horses.  A  daily  journal  is  kepi 
of  the  work  performed  each  day.  Outfits,  with  full 
directions  for  obtaining  specimens,  can  be  had  free 
at  any  of  the  Department  Supply  Stations.  (See 
Sec.  318.) 

Serological  specimens  are  prepared  for  examinatiou 
the  day  on  which  they  are  received,  and  examined  the 
following  day. 

Reports  are  made  on  the  third  day  after  the  speci- 
mens are  received  at  the  Laboratory.  At  least  five 
days  should  be  allowed  before  a  report  is  expected  on 

202 


;pecimens  sent  through  Department  supply  stations. 
|jl  results  are  entered  on  a  daily  list  (Form  180  L). 
'  All  information  and  all  reports  in  connection  with 
ersons  sulfering  from  venereal  diseases  are  regarded 
|s  absolutely  confidential  and  are  not  accessible  to  the 
ublic  nor  are  such  deemed  public  records. 

j         WASSERMANN  TEST   FOR    SYPHILIS. 

■  Sec.  267.  Outfits  supplied  to  physicians  for  coUect- 
■ag  blood  specimens  for  syphilis,  consist  of:  (1)  a 
terile  needle;  (2)  a  sterile  tightly  corked  tube,  all 
inclosed  in  a  wooden  box;  (3)  a  history  form 
163  L),  and  (4)  instructions  for  collecting  blood 
pecimens    (Form  233  L). 

'  The  results  of  Wassermann  tests  are  reported  to 
l.hysicians  by  mail   (Form  182  L). 

As  the  specimens  of  blood  to  be  examined  for  the 
Vassermann  reaction  deteriorate  very  quickly,  and 
0  should  be  examined  at  the  earliest  moment,  they 
:.re  issued  only  to  those  supply  stations  visited  daily 
'ly  collectors  of  the  Diagnosis  Laboratory. 

The  Wassermann  outfits  are  relatively  costly,  and, 
iis  is  the  case  with  other  outfits  supplied  by  the  De- 
>artment  of  Health,  many  are  never  returned  to  the 
:iaboratory,  being  used  by  physicians  and  druggists 
or  other  than  their  intended  purpose.  The  druggists 
jire,  therefore,  required  to  obtain  a  receipt  from  the 
')hysician  for  each  outfit  issued.  These  receipts  (Form 
537  L),  which  are  issued  with  the  outfit,  are  for- 
varded  through  the  collectors  to  the  Laboratory. 
Should  no  specimen  of  blood  be  received  at  the  Labor- 
itory  within  a  few  days,  the  physician  is  communi- 
*ated  with  by  mail  or  telephone. 

203 


INTERPRETATION  OF  THE  WASSERMANN 

READINGS. 
Section  208. 

xxxx  means  VERY  STRONGLY  POSITIVE. 
XXX  means  STRONGLY  POSITIVE. 
XX  means  POSITIVE. 
X  means  WEAKLY  POSITIVE. 
X  means  DOUBTFUL. 
-^means  NEGATIVE. 

A  diagnosis  of  sypliilis  should  never  be  read  froil 
a  weakly  positive  or  doubtful  reaction  (x  or  x  ), 

But  in  a  known  case  of  syphilis  that  has  had  specifi<f' 
treatment  such  a  reaction  would  indicate  the  necessit; 
of  further  treatment. 

A  weakly  positive  or  doubtful  reaction  (x  or  x ) 
where  there  is  no  specific  history  and  where  the  tes 
is  made  simply  as  an  aid  in  differential  diagnosis,  i 
usually  considered  as  negative. 

A  negative  Wassermann  reaction  does  not  absolutel; 
exclude  the  possibility  of  syphilitic  infection. 

GONORRHEA. 

THE   COMPLEMENT   FIXATION  TEST. 

Sec.  269.  The  same  outfits  that  are  used  for  col 
lecting  blood  specimens  for  the  Wassermann  test  an 
used  for  the  gonorrheal  tests.  The  results  of  the  com 
plement  fixation  tests  for  gonorrhea  are  reported  t( 
physicians  by  mail  (Form  199  L).  The  results  of  thes( 
tests  are  reported  as  Positive,  Negative  and  Doubtful 

204 


SMEAR  EXAMINATIONS  FOR  PRESENCE  OF 
GONOCOCGI. 

Sec.  270.  Outfits  for  preparing  smears  for  exami- 
lation  for  the  presence  of  gonococci  consist  of  two 
?lean  slides  in  a  wooden  slide  case,  and  a  case  history 
(Form  219 L) .  Complete  directions  for  making  smears 
ippear  on  the  reverse  side  of  the  history  blank.  Re- 
mits are  reported  to  physicians  by  mail  (Form  220  L). 

SYMBOLS    USED    IN   REPORTING    RESULTS    OF 
EXAMINATIONS  OF  GONOCOCCUS  SMEARS. 
Sec.  271. 

X.  Presence  of  Gram-negative  intracellular 
diplococci  having  the  morphological  characteris- 
tics of  the  gonoccoccus. 

— .  Absence  of  Gram-negative  intracellular  dip- 
lococci having  the  morphological  characteristics 
of  the  gonococcus. 

S.  Suspicious ;  for,  while  no  characteristic  dip- 
lococci are  found,  the  number  of  pus  corpuscles 
present  suggest  the  possibility  of  gonococci'  being 
found  in  another  specimen. 

D.  Doubtful ;  because  the  morphological  char- 
acteristics of  the  cocci  present  are  such  as  render 
j       their  classification  doubtful. 

In  all  cases  where  the  result  of  examination  is  un- 
satisfactory, the  physician  is  urged  to  send  in  another 
specimen. 

TREPONEMA  PALLIDUM  EXAMINATION. 
Sec.  272.    In  suitable  cases,  examinations  of  freshly 
jrepared  specimens  for   the  treponema  pallidum  are 
iiade   at   the   Department   Headquarters   Clinic,    149 

205 


Centre  Street.  As  this  test  can  only  be  satisfactoril; 
made  on  freslily  prepared  specimens,  it  is  necessar; 
for  the  patient  to  appear  in  person  at  the  Headquar 
ters  Clinic,  between  the  hours  of  9  and  11  A.  M 
A  history  (Form  235  L)  is  taken  of  each  case  and  j 
report  (Form  49  L)  of  the  result  of  examination  ii 
made  to  the  physician. 

ADVERTISING  VENEREAL  QUACKS. 

Sec.  273.  The  following  advertisement  is  carried  ii 
the  daily  papers  as  a  part  of  the  crusade  against  ad 
vertising  venereal  quacks:  FREE  advice  regardinj 
venereal  diseases  can  be  obtained  at  the  Departmen 
of  Health,  149  Centre  Street,  room  No.  802,  on  Mon 
days,  Wednesdays  and  Fridays  from  2  to  4  P.  M. 
and  on  Tuesdays,  Thursdays  and  Saturdays  from  ! 
to  11  A.  M.    All  consultations  are  strictly  confidential 

Tin  signs  bearing  practically  the  same  text  ari 
placed  in  toilets  of  restaurants,  bars,  railway  tei 
minals,  elevated  and  subway  stations. 

CIRCULARS  OF  INFORMATION. 

Sec.  274.  The  following  circulars  of  informatioi 
are  issued:  Circular  of  Information  Regarding  Ve 
nereal  Diseases  (Form  164  L)  ;  Important  Informatioi 
Regarding  the  Wassermann  Reaction  for  Syphilii 
(Form  172  L)  ;  Instructions  to  those  having  Syphilii 
(Form  224  L)  ;  Instructions  to  those  having  Gonor 
rhoea   (Form  223  L). 

Circular  letters  are  from  time  to  time  sent  physi 
cians  to  acquaint  them  with  the  work  and  methods 
of  the  Department  and  to  obtain  their  interest  an( 
co-operation. 

206 


GLANDERS. 

Sec.  275.  Investigation  of  cases  of  glanders  in 
)rses  is  under  the  cliarge  of  the  Chief  Veterinarian, 
e  submits  a  weekly  report  (Form  254  L).  One  or 
ore  veterinarians  are  on  duty  in  each  Borough 
ffice.  They  submit  daily  reports  (Form  165 J), 
hich  are  summated  on  an  individual  loose-leaf  sheet 
Form  166  J)  showing  the  work  of  that  particular 
iterinarian  for  a  period  of  fifty-two  weeks. 
Outfits  for  collecting  blood  specimens  for  the  com- 
ement  fixation  test  for  glanders,  consist  of  a  tightly 
irked  sterile  bottle,  and  a  case  history  (Form  122  L), 
ith  complete  directions  for  collecting  blood  speci- 
eus  on  the  reverse  side.  These  outfits  may  be  ob- 
ined  by  any  veterinarian  upon  application  to  the 
orough  Offices  of  the  Department  of  Health.  The  re- 
ilts  of  glanders  complement  fixation  tests  are  re- 
)rted  (Form  213  L)  to  the  veterinarians  as  positive, 
i-gative  or  suspicious.  The  final  outcome  of  the  case 
reported  to  the  Laboratory  by  postal  (Form  121  L). 

GENERAL  PROCEDURE. 

NOTIFICATION. 

Sec.  276.    Cases  of  glanders  are  reported  to  the  De- 

utment  of  Health,  either  as  clinical  cases  by  letter 
■  telephone,  or  by  laboratory  test. 

REGISTRATION. 
Sec.  277.  Each  case  is  given  a  serial  number  by 
hich  it  is  filed.  A  case  envelope  (Form  69  J)  is 
ade  out  for  every  case,  in  which  the  history  (Form 
'A  L)  is  eventually  filed  in  the  Borough  Office.  A 
leoial  chart  Is  kept  in  each  Borough  Office  on  which 
e  entered  the  current  data  regarding  each  case. 

2(X7 


INVESTIGATION. 

Sec.   278.    All    reported   facts   are  entered   on   a 
assignment  blank   (Form  72  J),  and  the  case  is  a 

signed  by  telephone  to  the  proper  Borough  veter 
narian  who  immediately  visits  the  stable  and  tak< 
blood  specimens  from  every  horse  therein,  and  fo 
wards  same  to  the  Serological  Laboratory.  He  sul 
mits  a  report  by  telephone  which  is  entered  on  tt 
assignment  blank.  He  also  fills  out  and  forwards 
history  of  the  case  (Form  234  L).  All  cases  giving 
positive  complement  fixation  test  are  checked  wit 
the  ophthalmic  mallein  test  (Form  126  J),  condemns 
(Form  70  J),  and  turned  over  to  the  State  Departmei 
of  Agriculture  for  appraisal  and  slaughter.  Stabl< 
are  placarded  (Form  4  J)  to  prevent  other  hors( 
being  taken  in.  In  cases  where  the  owner  signs  a 
immediate  release  (Form  21  J)  the  horse  is  slaughters 
without  State  appraisal.  Post-mortem  examinatioi 
are  held  on  all  horses  slaughtered  by  the  State  Depar 
ment  of  Agriculture.  All  horses  giving  doubtful  ( 
suspicious  reactions  are  held  under  provisional  qua 
antine,  and  tested  at  short  intervals  until  it  can  be  d 
cided  whether  or  not  they  are  glandered. 

DISINFECTION  OF  STABLES  AFTER  GLANDERi 

Sec.  279.  The  veterinarian  orders^  the  necessai 
disinfection  of  stables  (Form  71J).  All  flooring  ar 
other  woodwork  that  might  be  a  source  of  danger 
removed  and  destroyed.  The  rest  of  the  woodwor 
and  all  mangers,  drinking  troughs,  hayracks,  etc.,  n< 
destroyed  are  thoroughly  scrubbed  with  a  stiff  brus 
and  a  hot  solution  of  sodium  carbonate,  one-third  < 
a  pound  to  the  gallon.  Harness,  etc.,  is  also  scrubbe 
with  hot  soda  solution. 

208 


RABIES. 

GENERAL  PROCEDURE. 

Sec.  280.  By  virtue  of  the  authority  vested  in  the 
•epartment  of  Health  by  the  Sanitary  Code  (See  Sec. 

t),  all  complaints  of  dog  bites,  or  of  suspected  rabies 
re  immediately  investigated  by  the  Division  of  Ve- 
ereal  and  Veterinary  Diseases  and  appropriate  action 
aken.    A  weekly  report   (Form  254  L)   is  submitted. 

NOTIFICATION    AND    REGISTRATION. 

NOTIFICATION. 

Sec.  281.  Complaints  are  received  at  the  Borough 
)ffice  by  telephone,  letter  or  personal  visit. 

REGISTRATION. 

Each  case  is  given  a  serial  number  by  which  it  is 
iled.  A  case  envelope  (Form  32  J)  is  made  out,  in 
vhich  the  history  (Form  248  L)  and  other  reports  are 
iled  in  the  Borough  Office.  All  current  data  are  en- 
ered  on  a  special  chart  in  the  Borough  Office. 

INVESTIGATION. 
i  Sec.  282.  Each  case  is  entered  on  an  assignment  history 
olank  (Form  73  J)  and  assigned  to  the  Sanitary  Police 
'or  investigation  and  report.  The  patrolman  visits 
)oth  the  injured  person  and  the  owner  of  the  animal ; 
examines  the  animal  for  viciousness  or  any  symptoms 
Df  illness,  and  if  conditions  warrant,  orders  the  dog 
lelivered  for  observation  to  the  shelter  of  the  American 
Society  for  the  Prevention  of  Cruelty  to  Animals.  The 
policeman  reports  to  the  Borough  Chief  (Forms  248  L 
and  73  J)  :  (a)  owner's  statement;  (b)  statement  of 

209 


4 


injured  person ;  (c)  whether  dog  is  vicious,  unheal 
or  probably  rabid;  (d)  whether  this  is  the  first  tim' 
the  dog  has  bitten  anyone.  In  the  Borough  Office  tw 
files  are  kept ;  one  that  gives  the  names  of  owners  i 
cases  of  bites  by  animals  owned  by  them  (this  fil 
has  been  kept  for  years)  ;  the  other  gives  the  addresse 
of  such  owners.  These,  by  cross  reference,  facilitat 
the  discovery  of  previous  offenses  charged  agains 
animals.  If  the  animal  is  rabid  or  "suspicious"  th 
case  is  referred  to  a  veterinary  for  diagnosis. 

All  rabid  animals  are  at  once  destroyed  and  thei 
heads  forwarded  to  the  Research  Laboratory  with  i 
request  (Form  33  J)  for  examination,  whence  a  repor 
is  received  (Form  IG  J). 

Vicious  animals  are  destroyed,  the  Borough  Chie 
forwarding  a  recommendation  to  that  effect  (Forn 
58  J).  Before  ordering  the  destruction  of  vicioui 
animals,  their  owners  are  given  a  hearing,  to  ascer 
tain  whether  there  are  extenuating  circumstances,  sucl 
as  provocation  by  children,  that  they  may  be  able  t( 
plead  in  the  animal's  behalf.  Owner's  consent  foi 
destruction  of  animals  is  obtained  whenever  possible 
Stray  animals  that  have  bitten  any  person  are  forth 
with  destroyed. 

Should  the  owner  refuse  to  consent  to  its  destrue 
tion,  the  animal  is  removed  by  the  Department  ol 
Health. 

All  persons  bitten  by  rabid  dogs  are  referred  to  one 
of  the  Department's  Anti-rabic  Clinics  for  treatment, 
the  family  physician  being  notified.  Persons  refusing 
to  attend  Clinic  are  warned  of  the  risk  they  incur, 
but  no  effort  is  made  to  compel  them  to  undergo 
treatment.    Patients  who  cease  clinic  attendance  before 

210 


he  course  of  treatment  is  completed,  are  visited  by  an 
•fficer  of  the  Health  Squad,  who  warns  them  of  their 
langer  and  advises  them  to  continue  treatment. 

JLINICS  FOR  ADMINISTRATION  OF  ANTI-RABIG 
TREATMENT. 

Sec.  283.  For  addresses  and  hours  see  Directory, 
5ec.  2. 

DIAGNOSIS  LABORATORY. 

SCOPE   OF  WORK. 

Sec.  284.  The  work  of  the  Diagnosis  Laboratory 
'onsists  of: 

The  free  examination  for  physicians  of,  (1)  cul- 
ures  from  cases  of  suspected  diphtheria,  (2)  sputum 
'or  tubercle  bacilli,  (3)  blood  for  Widal  reaction,  (4) 
irine  for  Ehrlich's  reaction,  (5)  blood  for  malarial 
Plasmodia,  and  (6)  spinal  fluid  for  meningococci.  The 
^reparation  and  distribution  to  supply  stations  of 
iiphtheria,  sputum,  typhoid  (blood  and  urine),  ma- 
aria,  meningitis,  gonococcus  and  Wassermann  outfits. 

HOURS  OF  EXAMINATION,  ETC. 

Sec.  285.  All  specimens  received  during  any  given 
lay  are  examined  on  the  morning  of  the  following 
3ay,  and  the  results  of  examinations  are  reported  by 
nail  to  the  attending  physicians  by  1  P.  M.  Results 
)f  examinations  of  primary  diphtheria  cultures,  and 
Df  typhoid,  meningitis,  and  malaria  specimens  are 
telephoned  to  the  attending  physician  if  his  tele- 
phone number  is  given.  Diphtheria  cultures  are  ex- 
imined  and  reported  on  Sundays  and  holidays,  as 
yvell  as  on  week  days. 

211 


The  Laboratory  is  open  from  7  A.  M.  until  5  P.  M. ; 
on  Saturdays,  Sundays  and  holidays  from  8  A.  M. 
until  noon.  The  laboratory  consists  of  the  office  of  the 
Assistant  Director,  wash  and  sterilizing  rooms,  a 
sputum  preparation  room,  a  preparation  room  (for 
all  specimens  other  than  sputum),  a  large  room  where 
examinations  are  made,  a  very  large  laboratory  where 
outfits  are  prepared,  a  store  room,  a  lavatory  and  an 
office  for  the  clerical  force  that  sends  out  reports  ol 
the  results  of  examinations. 

ROUTINE  PROCEDURE. 

Sec.  286.  All  specimens  brought  in  for  examination 
are  taken  to  the  proper  room.  There  they  are  opened, 
dated,  and  slip  and  specimen  marked  with  a  corre- 
sponding serial  "day"  number.  Slides,  with  corre- 
sponding day  number,  are  prepared  from  the  specimens 
on  the  day  following  collection.  Results  of  examina- 
tion are  reported  on  special  slips,  hereinafter  men- 
tioned, or  on  a  card  (Form  201  L).  After  examina- 
tions are  completed,  specimens  go  back  to  the  washi 
room  to  be  sterilized  in  the  autoclave  and  destroyed. 
All  culture  media  and  swabs  are  prepared  in  the  large 
laboratory  room.  The  entire  laboratory  is  thoroughly 
cleaned  every  morning,  beginning  at  7  a.  m.  Floors 
and  woodwork  are  washed  with  .5  per  cent,  carbolic: 
acid  solution,  and  desks  scrubbed  with  scouring  solu- 
tion. 

DUTIES  OF  THE  ASSISTANT  DIRECTOR. 
Sec.  287.  The  Assistant  Director  keeps  a  daily 
record  (Form  22  LL)  of  work  performed,  and  for- 
wards a  weekly  report  (Form  192  L)  at  10  A.  M. 
every  Monday,  giving  number  of  culture  tubes,  swabs 
and    other    outfits    prepared,    collections    made,    and 

212 


licroscopical     specimeng    prepared     and     examined, 

lassified  as  to  their  nature,  results,  and  Boroughs, 
ie  also  forwards  an  annual  report  of  the  work  of  the 
)iagnosis  Laboratory,  takes  inventories  of  stock  of 
lanks  at  stated  intervals,  and  keeps  a  diary  of  cur- 
ent  events. 

CIRCULARS  OF  INFORMATION. 

Sec.  288.  The  following  circulars  relating  to  the 
eneral  work  of  the  Diagnosis  Laboratory  are  issued: 
On  the  Work  and  Products  of  the  Laboratories  of 
le  Department  of  Health"  (Form  105  L)  ;  "Notice  to 
hysicians  Regarding  the  Work  of  the  Laboratory" 
Form  IL).  List  of  Supply  Stations  and  Informa- 
on  Concerning  the  Bureau  of  Infectious  Diseases 
Form  206  L). 

DIPHTHERIA. 

OUTFITS    FOR   OBTAINING    CULTURES. 

Sec.  289.  Outfits  supplied  to  physicians  consist  of 
1)  culture  tube  (slant  of  Loeffler's  blood  serum,)  (2) 
ibe  containing  sterile  cotton  swab  on  wooden  stick, 
3)  culture  slips,  giving  full  instructions  and  calling 
)r  necessary  data,  (a)  white  "primary  slip"  (Form 
1  L)   for  first  or  primary  cultures;    (b)   blue  "later 

ip"  (Form  26  L)  for  secondary  or  later  cultures, 
ad  (4)  a  brown  paper  envelope  (Form  195  L)  to 
)ntain  tube,  swab  and  slip,  directed  to  the  Diagnosis 
aboratory,  Department  of  Health.  The  "primary" 
Qd  "later"  slips  used  in  the  various  Boroughs  and  by 
le  Department  hospitals  are  stamped  as  follows  in 
irge  letters  to  facilitate  their  ready  recognition, 
hose  in  Manhattan  unstamped;  in  Brooklyn,  B. ;  In 
ueens,  Q. ;  in  Richmond,  R. ;  in  Bronx,  Bx. ;  in  King- 

213 


ston  Avenue  Hospital,  K. ;  in  Willard  Parker  Hosi 
tal,  W.  P. ;  in  Riverside  Hospital,  N.  B. ;  and  in  oth 
institutions,  C.  Cultures  taken  in  the  Willard  Park( 
Riverside  and  Kingston  Avenue  Hospitals  of  the  E 
partment  are  also  accompanied  by  a  list  (Form  281 
giving  name,  address,  and  day  number.  This  d 
number  is  given  at  the  hospital,  and  marked  on  tul. 
slip  and  list. 

PREPARATION  AND  EXAMINATION  OF  CUL- 
TURES. 

Sec.  290.  Each  "primary"  culture  tube,  wh 
brought  in  at  night  by  the  collector,  is  marked  wi 
a  serial  "day"  number  ("later"  cultures  with  1 
ters),  placed  serially  in  a  rack,  and  incubated  i' 
about  thirteen  hours  over  night.  In  Brooklyn,  Broi, 
Queens  and  Richmond,  this  marking,  and  incubati; 
racking  is  done  at  the  respective  Borough  OflBces,  a  I 
the  cultures  are  brought  to  the  Diagnosis  Laboratc 
on  the  following  morning.  Preparation  of  specimf? 
for  microscopical  examinations  begins  at  7  A.  M. 
means  of  a  platinum  loop,  thin  films  of  the  growth  i 
the  culture  medium  are  spread  on  glass  sli(i 
(marked  with  corresponding  day  number  or  lette, 
three  films  on  a  slide,  dried,  fixed  with  heat,  a  I 
stained  with  Loefifler's  alkaline  methylene  blue  so- 
tion.  Microscopical  examination  begins  at  8 :00  A.  • 
at  which  time  the  slides,  tubes,  culture  slips  and  lis 
are  ready.  Each  specimen  is  examined  by  a  b- 
teriological  diagnostician.  The  diagnosis  is  read  J 
by  taking  into  consideration  (a)  the  miscroscopii 
picture,  (b)  the  cultured  characteristics  of  the  grovs', 
and  (c)  the  clinical  data  as  furnished  by  the  phy 
cian. 

214 


ABBREVIATIONS   OF   RESULTS. 

Sec.  291.  In  the  proper  space  on  each  slip  are 
placed  the  date,  result  of  examination,  and  initials 
of  the  diagnostician.  The  results  are  also  marked  on 
the  lists.    The  following  abbreviations  are  used : 

"L" Diphtheria  bacilli  present. 

'No  L" No  diphtheria  bacilli  present. 

"Unsat"  Unsatisfactory,    due    to    one    of    the 

three  following  conditions : 

"Susp."   Suspicious  bacilli  present. 

"Contam."   Culture  contaminated. 

"No  Growth" . .  No  growth. 

In  case  of  scanty  or  insufficient  growth  on  the 
culture  medium,  the  word  "scanty"  is  written  across 
the  upper  right-hand  corner  of  the  slip,  and  the  cul- 
ture tube  put  back  in  the  incubator.  Scanty  primary 
cultures  from  cases  with  a  clinical  diagnosis  of  diph- 
theria, age  less  than  eighteen  years,  and  with  media 
in  good  condition,  are  re-examined  the  afternoon 
of  the  same  day  (except  Saturdays)  and  results  re- 
ported. All  others  are  examined  on  the  next  morn- 
ing, after  a  preliminary  report  has  been  sent  to  the 
attending  physician  stating  the  cause  of  delay. 

TEST   FOR  VIRULENCE. 

Sec.  292.  Cultures  showing  apparently  typical 
diphtheria  bacilli  are  tested  for  virulence  (1)  on  re- 
quest of  attending  physician ;  and  (2)  in  all  cases 
where  original  clinical  diagnosis  of  diphtheria  was 
doubtful,  and  duration  of  disease  is  four  weeks  or 
over.  The  culture  tube  and  a  record  of  the  case  are 
«ent  to  the  Research  Laboratory  of  the  Department 

215 


of  Health  as  soon  as  possible.  A  card  index  is  kepi 
of  all  data  and  results  (Form  205  L).  When  viru 
lence  or  non-virulence  has  been  determined  througl 
test  on  animals  (requiring  about  ten  days),  the  re 
suit  is  forwarded  by  mail  to  the  Diagnosis  Labora 
tory,  entered  in  the  index,  and  the  attending  physi 
clan,  diphtheria  clerks  and  Division  of  Contagion: 
Diseases  are  notified. 

STERILIZATION   OF   CULTURES   AND   STORAG] 
OF  SLIDES. 

Sec.  293.  On  completion  of  examination  the  cu 
ture  tubes  are  sterilized  in  the  autoclave.  They  ar 
then  boiled  in  a  solution  of  potash,  washed  out  thoi 
oughly  with  soap  and  water,  and  allowed  to  dr; 
They  are  then  ready  for  further  use. 

On  completion  of  daily  examination  the  glass  slide 
are  stored  in  a  cabinet  for  twenty  days  for  possib 

reference,  and  are  then  destroyed. 

m 

RECORDING  AND  REPORTING  OF  RESULTS 

Sec.  294.  After  the  result  of  examination  has  be( 
reported,  all  culture  slips  are  filed  according  to  a 
dress  of  the  patient,  in  printed  envelopes  (For 
30  L).  Manhattan  cases  in  the  laboratory,  and  tl 
others  in  the  various  Borough  Offices  as  long  as  tl 
cases  are  active.  When  terminated,  the  envelopes  ai 
slips  are  filed  in  the  record  envelope  of  the  case, 
the  terminated  case  file  in  the  Borough  Office. 

All  culture  slips,  as  soon  as  brought  in,  are  stamp 
with  the  date  of  collection,  given  a  serial  number 
letter  corresponding  to  that  of  the  culture  tube,  a 
are  then  compared  with  the  above-mentioned  dip 

216 


theria  index.    According  to  result  of  comparison  they 
ire  classed  as  follows : 

'Primary"  Slips   ...    No  previous  culture  taken. 
'Confirmatory"    Slips. A  previous   culture,   but  result 

negative  or  doubtful. 

'Later"   Slips   . ./ Previous    culture    sbowed     the 

presence  of  diphtheria  bacilli. 

When  a  wrong  slip  has  been  used  (white  for  a 
later  or  blue  for  a  primary  culture),  the  word  pri- 
Liiiiry  or  later,  as  the  case  may  be,  is  written  across 
the  face  of  the  slip.  In  the  case  of  confirma- 
.tory  cultures,  all  previous  slips  are  attached  and 
C'onf.,  together  with  the  original  laboratory  or  case 
Qumber,  written  on  the  slip.  In  Brooklyn,  Bronx, 
Queens  and  Richmond  the  above  marking  is  done  by 
the  collector  on  his  return  from  his  route. 

CULTURE  LISTS. 

Sec.  295.  A  collector  makes  out  every  night  dupli- 
;-ate  laboratory  and  culture  lists  (Form  6L)  for  each 
Borough.  These  lists  contain  the  day  number  of  the 
I'ulture ;  the  name,  age  and  address  of  the  patient, 
the  attending  physician's  name  and  telephone  num- 
jer,  the  diagnosis,  and  nature  of  the  culture  (pri- 
mary or  later).  One  list  is  carried  to  the  Diagnosis 
Laboratory  and  filed  there.  The  duplicate  list  of  each 
Borough  is  left  in  the  Borough  Office;  on  it  are 
cnarked  the  results  of  examination  as  received  by 
'••If'phone  the  next  morning  from  the  Diagnosis  Lab- 
oratory. After  results  are  telephoned  to  the  attend- 
ing physicians,  this  Borough  culture  list  is  forwarded 
LO  the  Division  of  Contagious  Diseases  of  the  Bor- 
ough. 

217 


i 
As  soon  as  the  examination  of  the  cultures  from 
each  Borough  is  completed,  the  slips  are  forwarded 
to  the  various  Borough  Offices  by  messengers. 

ROUTINE  PROCEDURE  IN  BOROUGH   OFFICES. 

Sec.  296.  The  results  of  examination  of  all  primary 
cultures  taken  from  the  culture  list  are  first  tele- 
phoned to  the  attending  physicians.  In  the  case  of 
Brooklyn  and  Bronx  cultures,  this  is  done  from  the 
Diagnosis  Laboratory. 

Each  primary  slip  is  then  assigned  a  serial  lab- 
oratory or  case  number  (running  from  January  1  to 
December    31). 

The  culture  list  (Form  6L)  sent  daily  to  the 
Division  of  Contagious  Diseases  gives  the  following 
information : 

(a)  Primary  cultures. — Duration  of  disease,  clin- 
ical diagnosis,  name,  age  and  address  of  the  patient, 
name,  address,  and  telephone  number  of  attending 
physician,  whether  culture  was  taken  by  inspector  or 
physician,  and  result  of  examination. 

(b)  Later  cultures. — The  same  information  with 
the  exception  of  clinical  diagnosis. 

(c)  School  cultures. — Name,  age,  and  address  of 
all  cases  where  the  cultures  taken  by  school  inspectors 
show  diphtheria  bacilli. 

Written  reports  for  mailing  are  made  out  on  spe- 
cial blanks,  as  follows: 

Primary  "L"  (diphtheria  bacilli  present,  Form 
22  L),  red. 

"No  L"  (diphtheria  bacilli  absent.  Form  24  L), 
white. 

218 


"Unsatisfactory"    (result    of    examination    unsatls- 

ctory;    another    culture    requested,    Form    265   L), 

hite. 

Later.    "L"  (diphtheria  bacilli  present,  Form  57  L), 

ue. 

*'No  li"    (diphtheria  bacilli   absent,   Form  .56   L), 

»llow. 

These  reports  are  sent  to  the  attending  physician 

7  the  Diagnosis  Laboratory;  and  to  the  Branch  Of- 

:e  in  whose  district  the  patient  resides  by  the  Bor- 

jgh  Office.     A  clerk  in  the  Borough  Office  assigns 

le  reports  and  forwards  them  to  the  various  Branch 

ffices.     All  reports  are  compared  with  the  original 

ilture  slips  from  which  they  are  made  out,  before 

3ing  signed.    In  Manhattan  and  other  Boroughs  this 

^  done  by  the  diphtheria  clerks. 

All  written  reports  are  mailed  before  12:30  P.  M., 
)  reach  the  physician  on  the  same  afternoon. 

All  slips  are  filed  in  manila  envelopes  (Form  SOL), 
Q  the  outside  of  which  are  entered  the  necessary 
ata. 

CULTURES  FROM  SCHOOL  CHILDREN. 

Sec.  297.  School  inspectors  forward  two  slips  with 
ach  culture  (Form  16  K).  A  written  report  is  mailed 
)  the  inspector  who  has  made  the  culture;  one  slip 
;  filed  in  the  diphtheria  index  of  the  Diagnosis  Lab- 
ratory  and  the  other  is  sent  from  the  Diagnosis 
'.aboratory  to  the  Borough  Office  of  the  Bureau  of 
liild  Hygiene  corresponding  to  the  address  of  the 
ase.  School  cultures  showing  diphtheria  bacilli  are 
eported  to  each  Borough  Office  on  the  daily  culture 

219 


list,  also  by  a  duplicate  report  (inspector's  nam 
omitted),  worded,  "school  culture."  Such  "school 
cultures  are  listed  and  examined  after  the  "later 
cultures. 

CULTURES  FROM  DEPARTMENT  HOSPITALS. 

Sec.  298.  Results  of  examinations  of  cultures  fror 
Department  hospitals  are  reported  on  the  special  list 
(Form  28  L)  forwarded  for  that  purpose  from  ead 
hospital.  These  lists,  with  results  marked  thereor 
are  returned  by  messenger  or  mail.  The  results  ari 
also  telephoned  to  the  hospitals,  and  the  slips  filei 
in  the  OfiBce  of  the  Borough  in  which  the  patien 
lives. 

EXAMINATIONS  ON  SUNDAYS  AND  HOLIDAYS 

Sec.  299.  On  Sundays  and  holidays  the  results  o 
examination  of  all  primary  cultures  are  reported  t< 
the  attending  physician  by  telephone  and  mail  direc 
from  the  Diagnosis  Laboratory.  The  culture  list  fo: 
Manhattan  is  filled  out  and  sent  as  soon  as  possibL 
to  the  Department  telephone  operator,  to  whom  al 
telephone  requests  for  information  are  referred.  Thi 
results  of  the  examination  of  all  later  cultures  are  no 
reported  to  physicians  and  inspectors  until  the  fol 
lowing  morning. 

The  forwarding  of  slips  to  Borough  Offices  is  de 
f erred  until  the  following  day. 

PREPARATION    OF    DIPHTHERIA   CULTURE 
MEDIA. 

Sec.  3(X).  The  blood  is  obtained  from  cattle  killec 
in  slaughter-houses,  where  it  is  caught  in  jars  as  i 

220 


lows  from  a  knife  wound  in  the  heart  after  the 
nimal  has  been  stunned.  The  jars  are  then  covered 
.nd  allowed  to  stand  until  the  blood  clots,  after  which 
hey  are  placed  in  cold  storage.  The  serum  is  later 
yphoned  off  into  clean  flasks. 

Loeffler's  mixture,  consisting  of  three  parts  serum 
nd  one  part  of  1  per  cent,  glucose  broth,  is  used  for 
illing  the  culture  tubes.  Four  c.  c.  of  this  mixture 
;re  run  into  the  tubes  which  have  previously  been 
terilized  with  dry  heat  for  one  hour  at  150  de- 
;rees  C. 

The  tubes  containing  the  media  are  sterilized  in 
he  following  manner :  They  are  placed  in  an  in- 
lined  position  in  the  Arnold  steam  sterilizer  and 
terilized  for  one  hour  on  three  successive  days.  On 
he  first  day  the  temperature  is  not  allowed  to  go 
ibove  90  degrees  C.  Ebullition  is  in  this  way  pre- 
ented  and  the  serum  becomes  slowly  and  evenly 
lardened.  On  the  second  day  the  temperature  is  not 
.llowed  to  go  above  95  degrees  C.  The  serum,  on 
he  third  day,  can  stand  100  degrees  C.  without  im- 
jairment  of  its  quality.  Blank  labels  are  then  affixed, 
ifter  which  the  tubes  are  ready  for  distribution.  All 
ubes  for  supply  stations  are  capped  with  paraffine  to 
)revent  drying. 

CIRCULAR  OF  INFORMATION. 

Sec.  301.  The  circular  in  reference  to  diphtheria 
ssued  to  physicians  and  those  interested  is: — Circu- 
ar  of  Information  Regarding  Causation,  Diagnosis 
md  Treatment  of  Diphtheria  (Form  19  J). 

221 


TUBERCULOSIS,    TYPHOID    (WIDAL,    DIAZO), 
MALARIA,  AND  MENINGITIS 

ROUTINE    PROCEDURE. 

Sec.  302.  Tlie  slips  accompanying  specimens  from 
suspected  cases  of  the  above  mentioned  diseases  are 
filed  for  record  in  each  proper  Borough  Office.  There 
is  a  separate  index  for  each  disease.  Every  slip,  with 
the  exception  of  those  from  cases  of  tuberculosis,  is 
stamped  by  the  collector  on  the  day  collected,  with 
the  corresponding  date  at  each  Borough  Office,  and 
given  the  same  serial  "day"  number  as  the  specimen. 
Each  slip  is  then  compared  with  the  record  index, 
when  all  previous  slips  from  the  same  patient  are 
attached.  Tuberculosis  slips  are  dated  and  marked 
at  the  Diagnosis  Laboratory  on  the  following  morn- 
ing. If  the  slip  is  new  or  "primary,"  it  receives  u 
"laboratory"  or  case  number,  running  from  January 
1  to  December  31.  The  day  number,  patient's  name 
and  address,  and  physician's  name  and  telephone 
number  are  entered  on  a  special  list  (Form  193  L) 
for  each  Borough.  The  names  and  addresses  of  all 
cases  showing  "true"  or  "positive"  results,  and  of 
negative  cases  which  the  attending  physician  wishes 
considered  "true,"  are  reported  to  the  Borough  Chief 
of  the  Borough  in  which  the  patient  resides  (Forms 
126  and  11  L).  A  daily  record  (Form  22  LL)  is  kept 
for  each  Borough  of  the  total  number  of  specimens 
examined,  including  diphtheria  cultures,  and  also  the 
number  of  visits  made  to  stations,  number  of  culture 
tubes,  swabs,  sputum  jars  and  other  outfits  prepared ; 
also  the  number  of  specimens  sent  in  by  private  phy-i 
sicians  and  inspectors.     All  slips  are  returned  to  the 

222 


;pective  Borough  Offices  by  messenger,  where  a 
ing  envelope  is  made  out  for  each  new  slip. 

The  results  of  examination  for  typhoid,  meningitis 
{d  malaria  are  telephoned  from  the  laboratory  list 
1  the  attending  physician.  Results  of  examinations 
;5  not  given  to  the  patient,  except  at  the  request 
(  the  physician,  or  when  there  is  no  physician  in 
tendance.  All  examinations  are  limited  to  speci- 
iins  from  persons  residing  in  New  York  City,  and 
(  the  Croton  water  shed. 


TUBERCULOSIS. 
SPUTUM  OUTFITS. 

"iSec.  303.  The  sputum  outfit  furnished  consists  of  a 
'ill-corked  glass  jar,  bearing  the  name  of  the  De- 
irtment  of  Health  in  raised  letters,  with  a  blank 
3 el,  and  a  sputum  slip  (Form  SSL)  for  the  re- 
>  ired  data ;  on  the  reverse  side  are  given  instructions 
T  obtaining  the  specimen. 

METHOD  OF  PREPARATION,  EXAMINATION 
AND  REPORTING. 

Sec.  304.  At  7  A.  M.  of  every  week  day  except 
•lidays,  the  Manhattan  and  Brooklyn  sputum  speci- 
,ens  collected  on  the  day  before  are  prepared  for 
amination.  Brooklyn  specimens  are  brought  to  the 
boratory  in  the  evening  after  collection.  Bronx, 
jeens  and  Richmond  specimens  and  lists  are  pre- 
ired  at  9  A.  M.  All  slips,  after  they  are  marked 
id  dated,  are  sterilized  for  one  hour  in  an  Arnold 
erilizer. 

223 


Two  laboratory  assistants  are  assigned  to  the  dut 
of  preparing  the  specimens.  A  moderately  thin  smea 
of  selected  portions  of  the  sputum,  representing  i 
area  two  cover-glasses,  is  spread  on  a  new  glass  slid< 
The  "day"  number  is  marked  on  the  slide  with  a  dif 
mond.  The  slides  are  dried  on  an  Ehrlich  plat( 
After  they  are  dried  and  fixed  they  are  covered  sei 
arately  with  fresh  carbol  fuchsin  water,  and  heate 
to  steaming  for  five  minutes.  They  are  then  washe 
in  running  water,  decolorized  in  acid  alcohol  (3  pe 
cent  hydrochloric  acid  in  70  per  cent,  alcohol),  an 
counterstained  with  methylene  blue.  A  blank  lab( 
for  marking  result  of  examination  is  then  affixec 
Watery,  oily  or  dried  samples  receive  special  atter 
tion.  Leaky  or  improperly  preserved  specimens  ar 
not  examined,  notice  of  this  fact  being  sent  to  th 
physician  concerned  (Form  173  L).  The  same  is  tru 
of  specimens  forwarded  without  the  name  and  ac 
dress  of  the  patient  (Form  45  L)  or  of  the  attendiu 
physician  (Form  247  L).  Microscopical  examinatioD 
begin  at  9  A.  M.  Twelve  laboratory  assistants  ar 
detailed  for  this  work.  A  rapid,  superficial  examine 
tion  is  first  made  to  exclude  all  specimens  showing 
large  number  of  tubercle  bacilli.  The  remaining  spec 
mens  receive  a  millimetre  search  by  the  use  of 
mechanical  stage. 

ANTIFORMIN  METHOD. 
Sec.  305.     All  specimens  failing  to  show  tubercl 
bacilli   are   examined   by  the   antiformin   method   a 
follows : 

Five  c.  c.  of  the  sputum  in  sputum  jar  as  receive 
at  Laboratory  is  mixed  with  an  equal  volume  of  ant 
formin,  previously  diluted  with  three  parts  of  wate: 

224 


The  sputum-antiformin  mixture  is  then  shaken  for 
Dout  fifteen  minutes  by  means  of  a  mechanical 
laker,  and  is  allowed  to  stand  until  fluidification  Is 
)mplete. 

The  mixture  is  then  diluted  with  an  equal  volume 
;  alcohol  and  centrifuged  for  half  an  hour.  The 
ipernatant  fluid  is  then  poured  off,  more  alcohol  is 
ided,  and  the  mixture  recentrifuged.  The  latter 
:ep  may  be  omitted  if  a  good  sediment  is  obtained 
fter  the  first  centrifuging. 

Smears  made  from  the  sediment  are  stained  as 
escribed  above. 

REPORTS. 

Sec.  S06.  Results  of  examination  are  marked  on 
le  slide;  also  in  the  proper  place  on  the  slip,  to- 
ether  with  the  initials  of  the  examiner.  The  terms 
sed  for  marking  are  "positive"  and  "negative."  All 
lides  are  stored  in  a  special  cabinet  twenty  days. 
Vritten  reports  of  positive  results  (Form  97  L)  and 
f  negative  results  (Form  39  L)  are  sent  to  the 
hysician.  Every  case  whose  sputum  shows  tubercle 
acilli,  and  every  case  which  the  attending  physician 
risbes  to  be  considered  as  tuberculosis  despite  ab- 
lence  of  tubercle  bacilli,  is  reported  to  the  proper 
[Jorough  Office  on  a  tuberculosis  tally  card  (Form 
26  L).  All  cases  of  children  under  sixteen  years 
bowing  tubercle  bacilli  are  also  reported  to  the  Ex- 
cut  ive  Office. 

All  slips,  on  completion  of  the  examination  and 
eporting  of  results,  are  forwarded  to  the  proper 
Jorough  Oflices,  where  they  are  filed  in  special  en- 
elopes  (Form  138  L). 

225 


TYPHOID  FEVER. 

THE  WIDAL  REACTION. 

WIDAL  OUTFIT. 

Sec.  307.  The  Widal  outfit  consists  of  the  folio 
ing  articles:  A  clean  glass  slide,  in  a  wooden  sli 
case,  closed  with  a  rubber  band;  a  slip,  giving  i 
structions  for  obtaining  the  specimen  (Form  1061 
and  for  all  necessary  data ;  and  a  circular  of  inform 
tion  regarding  the  tests  for  typhoid  fever,  the  ii 
portance  of  the  disinfection  of  urine,  etc.  (For 
34  L).  The  whole  outfit  is  inclosed  in  an  envelo] 
directed  to  the  Diagnosis  Laboratory   (Form  143  L 

TECHNIC    OF   EXAMINATION. 

Sec.  308.    The  dried  blood,  diluted  1-40,  is  used  t 
the  reaction.    A  fresh  bouillon  culture  of  the  typho" 
bacillus   is  prepared  every  night.     On  the  followii 
morning  this   culture  is   tested  for  its  motility  ar 
its  reaction  to  a  known  typhoid  blood. 

The  following  system  of  indicating  results  on  si 
is  used :  "positive" — a  complete  reaction  with  a  dil 
tion  of  1  to  40  within  from  thirty  to  sixty  minutes 
"negative" — no  reaction  within  the  same  time;  "i 
complete" — partial  clumping  and  partial  loss  < 
motility  of  bacilli.  Written  reports  (Form  40 L)  ai 
sent  to  the  attending  physician.  Results  are  tel 
phoned  from  "laboratory"  lists,  on  which  are  giv( 
telephone  numbers  and  names  of  physicians;  sli] 
are  filed  in  Borough  Offices  in  special  envelop* 
(Form  14  L).  When  a  case  is  terminated,  the  e: 
velopes  are  filed  in  the  record  envelope  of  the  cas 
in  the  terminated  case  file  in  the  Borough  Office. 

226 


ft 


EHRLICH'S    DIAZO    REACTION. 
DIAZO   OUTFIT. 


Sec.  809.  The  outfit  consists  of  a  stoppered  glass 
vial;  a  slip  for  data  (Form  159  L)  ;  and  a  circular 
of  information  (Form  34  L) — the  whole  inclosed  in 
a  screw-topped  wooden  box. 

TECHNIC  OF  EXAMINATION. 

Sec.  310.     Presence  or  absence  of  the  reaction  is 
determined  as  follows :  equal  parts  of  the  suspected 
urine   are   mixed   with   the   following   reagent — satu- 
rated solution  of  sulphanilic  acid  in  5  per  cent,  hy- 
drochloric   acid,    40    parts ;    0.5    per    cent,    solution 
sodium  nitrite,  1  part —  and  the  mixture  well  shaken. 
On  the  addition  of  a  few  drops  of  ammonia  a  bril- 
liant rose-pink   color   appears   when   the   reaction   is 
present.     The  twelve  hours'   sediment   is  also   char- 
acteristic, consisting  of  a  dirty  gray  lower  layer  and 
a  narrow  dark  olive  green  upper  layer.     The  result 
;  is   stated   on   the   slip   as    "positive,"    "negative,"   or 
I.  "doubtful."    Results  are  reported  and  filed  as  in  the 
case    of    Widal    specimens.      [Report    blank     (Form 
i;  161  L),  filing  envelope  (Form  160  L)]. 

All  typhoid  specimens,  bottles,  slides  and  tubes  are 
Hi  disinfected  in  1  to  20  carbolic  acid  on  completion  of 
/•  examination. 

f 

*  CIRCULAR  OF  INFORMATION. 

Sec.  311.  With  each  written  report  is  sent  a  copy 
'i  of  the  circular,  "How  to  Avoid  the  Contraction  and 
I   Prevent     the     Spread    of     Typhoid     Fever"     (Form 

227 


178  L) ,  with  the  request  that  the  attending  physician 
give  it  or  equivalent  instructions  to  the  family  6f  the 
patient. 

EXAMINATIONS  FOR  MALARIAL  ORGANISMS 

Sec.  312.     Outfit  consists  of  two  glass  slides,  in  a 

slide  box;  a  Hagedorn  needle;  a  slip  (Form  166  L) 
for  data  giving  all  instructions  for  obtaining  speci 
mens ;  and  a  circular  of  information  regarding  mala 
ria   (Form  33  L). 

A  modified  Nocht-Romanowsky  method  of  staining 
the  blood  is  used.  Results  of  examinations  are 
marked  on  slip,  and  reported  to  physicians  by  tele- 
phone  and  mail,   as   in   the  case   of   typhoid   fever 

[Report  blank  (Form  165  L),  filing  envelope  (Forn 
167  L)]. 

CEREBRO-SPINAL  MENINGITIS. 

Sec.  313.  Outfit  consists  of  a  well-corked  sterile; 
glass  vial,  slip  (Form  188  L),  and  circular  of  infer 
mat  ion  (Form  196  L),  all  inclosed  in  a  wooden  screw- 
topped  box.  Specimens  are  stained  with  Loeffler'f 
methylene  blue  and  by  Gram's  method.  The  pres- 
ence or  absence  of  meningococci  is  reported  to  the 
physician  by  telephone  and  mail,  as  in  the  case  oi 
typhoid  fever.  Report  blank  (Form  187  L),  filin? 
envelope  (Form  186  L). 

[Note. — The  examination  for  gonococci,  treponemc 
pallidum,  and  the  performance  of  the  complemen 
fixation  tests  for  syphilis,  gonorrhoea,  and  glanders 
are  carried  out  in  the  Serological  Laboratory  of  th( 
Division  of  Venereal  Diseases.] 

228 


OLLECTION    OF    SPECIMENS    AND    SUPERVI- 
SION OF  SUPPLY  STATIONS. 

SUPPLY  STATIONS. 

Sec.  314.  Various  pharmacies  throughout  New  York 
ity  keep  on  hand  culture  tubes,  diagnostic  outfits 
id  diphtheria  antitoxin  and  vaccine,  supplied  by 
le  Department  of  Health.  These  pharmacies  are 
aown  as  "supply  stations."  A  full  description  of 
lese  outfits  and  the  various  grades  of  antitoxin,  to- 
other with  a  full  list  of  supply  stations,  is  found  in 
le  circular  entitled  "Work  and  Products  of  the 
iagnosis,  Research  and  Vaccine  Laboratories"  (Form 
>5L).  A  list  of  the  supply  stations  in  condensed 
•rm  is  also  given  in  a  booklet  (Form  206  L). 

These  supply  stations  are  of  two  kinds: 

(a)  "Regular  stations,"  which  are  visited  daily 
^  collectors  and  supplied  directly  by  them  (in  all 
Droughs). 

(b)  "Sub-stations,"  which  obtain  supplies  on  re- 
lisition  (Form  148  L),  forwarded  by  mail  in  di- 
eted envelope  furnished  for  the  purpose,  or  through 
e  regular  stations,  and  which  deliver  specimens 
,.ily  to  the  regular  stations  before  the  collector  calls. 

1  stations  are  visited  at  least  once  a  month  by  sup- 
Y  wagons,  and  the  stock  of  supplies  inspected  and 
plenished. 

All  requisitions  after  they  are  filled  are  stamped 
th  the  date  and  initials  of  the  employee  who  put 
the  order.     They  are  then  filed  for  reference. 

Supply  stations  are  established  on  written   appli- 

229 


cation  to  the  Diagnosis  Laboratory.  Agreements  re 
lating  to  the  care  of  the  stations  must  be  signed  ir 
duplicate   (Form  15  L). 

A  card  index  (Form  120  L)  of  all  stations  is  kept 
This  index  records  stock  of  every  station  on  hand  a 
each  station.  The  monthly  visits  are  also  enterec 
on  a  large  chart,  from  which  the  route  of  the  suppl: 
wagon  is  laid  out  each  day. 

The  location  and  character  of  all  supply  station 
are  indicated  upon  maps  of  the  different  Borough 
by  means  of  colored  tacks. 


STOCK   OF   SUPPLIES   CARRIED   BY    STATIONS 

Sec.    315.      Supplies    carried    by    regular    station 
(minimum)  : 

Culture   tubes    i 2      Dozen 

Swabs    2      Dozen 

Culture   envelopes    2      Dozen 

Typhoid    outfits    (Widal) 1      Dozen 

Typhoid  outfits    (Diazo) 1      Dozen 

Meningitis    and    malaria    outfits, 

each    V2  Dozen 

Gonococcus  outfits V2  Dozen 

Sero-diagnostic   outfits    %  Dozen 

Primary  diphtheria  blanks  (Form 

21L)     5      Dozen 

Later    diphtheria    blanks     (Form 

26L)     ...5      Dozen 

Sputum   jars    3      Dozen 

Sputum   blanks    (Form   38  L) 5      Dozen 

Antitoxin    6      Bottles 

Vaccine    10      Tubes 

230 


The  blanks  for  Widal,  Diazo,  malaria  and  gonococ- 
jus  specimens  accompany  each  outfit. 

Supplies  carried  by  sub-stations  (minimum)  : 

Culture   tubes    12 

Swabs    ,12 

Culture    envelopes    12 

Sputum   jars    12 

Typhoid  outfits    (Widal)    6 

Typhoid  outfits    (Diazo)    6 

Meningitis   and  malaria  outfits,   each....     4 

Gonococcus  outfits   2 

Sero-diagnostic   outfits    2 

Primary  diphtheria  blanks   (Form  21 L).  12 

Later  diphtheria  blanks   (Form  26  L) 12 

Sputum  blanks    (Form  38  L) 12 

Antitoxin .i 6  Bottles 

Vaccine    10  Tubes 

The  proprietors  of  sub-stations  agree  in  writing 
;Form  15  L)  to  deliver  all  specimens  to  regular 
tations  at  an  appointed  time  each  day,  and  to  send 
or  packages  of  new  supplies  within  forty-eight  hours 
fter  notice  has  been  received.  Such  notice  is  sent 
ly  postal  card   (Form  145  L). 

DUTIES  OF  COLLECTORS. 

Sec.  316.  Incubators,  in  which  cultures  may  be 
ilaced  at  any  hoar,  are  maintained  in  connection 
nth  all  the  Borough  Offices. 

One  collector  in  each  Borough,  on  completing  his 
onnd,  is  designated  to  mark  each  culture  tube  and 
ts  slip  with  a  corresponding  serial  day  number,  to 
aake  out  the  laboratory  culture  lists  and  place  the 

231 


tubes  in  the  incubator.  The  typhoid,  sputum  and  ma- 
laria specimens  are  placed  in  the  boxes  provided 
therefor.  The  urine  specimens  are  placed  in  the  ice 
chest. 

When  the  collector  places  the  culture  tubes  in  the 
incubator  at  night,  he  notes  its  temperature  on  diph- 
theria culture  list  (P.  M.  temp degrees),  and 

again  when  he  removes  the  cultures  on  the  following 
morning    (A.   M.  temp degrees). 

In  Brooklyn,  Bronx,  Queens  and  Richmond  the 
collector  also  compares  all  diphtheria,  malaria  and 
typhoid  slips  with  the  Borough  Office  records  to  see 
if  any  previous  examiDation  has  been  made.  Every 
morning  the  collectors  bring  tubes,  slips  and  other 
specimens  to  the  Diagnosis  Laboratory  in  Manhat- 
tan, where  they  are  examined. 

Collectors  must  leave  the  Borough  Offices  promptly 
and  visit  the  supply  stations  according  to  schedule; 
in  no  instance  is  a  station  to  be  left  before  the  sched- 
uled time. 

The  collector  always  carries  the  hand-bag  furnished 
by  the  Department  and  a  full  stock  of  supplies.  Tele- 
phoning to  supply  stations  to  ask  if  there  is  any 
necessity  to  call  is  strictly  forbidden  under  penalty 
of  dismissal. 

The  stock  of  supplies  in  each  station  is  to  be  care- 
fully examined  daily,  especially  the  culture  tubes,  and 
all  spoiled  tubes  must  be  replaced.  If  the  number  ol 
other  outfits  is  deficient,  it  must  be  made  up  to  the 
required  amount. 

If  packages  for  sub-stations  remain  at  the  regulai 
stations    more   than   forty-eight   hours,   this   fact   U 

232 


I 


sported  to  the  Assistant  Director  of  the  Diagnosis 
Laboratory. 

All  carfare  vouchers  for  the  preceding  month,  prop- 
erly made  out  in  duplicate  and  sworn  to,  are  sub- 
mitted to  the  Assistant  Director  of  the  Diagnosis 
Laboratory  on  the  first  day  of  the  month  (Forma 
243-244  L).  A  record  of  the  daily  expenditures  of 
each  collector  is  kept  in  a  journal   (24LL). 

In  Manhattan  the  collectors  report  at  the  Diagnosis 
Laboratory  daily  at  3 :30  P.  M.,  and  put  up  all  orders 
for  supplies   which  may   have  been   received  during 

I  the  day  for  their  stations. 
One  collector  in  each  Borough  on  his  return  from 
his  rounds  collects  all  specimens  which  have  been 
■•■:  left  in  the  cabinets  located  in  the  halls  of  the  various 
Borough  Offices.  Special  attention  must  be  paid  to 
the  collection  of  all  fumigation  orders  left  at  the 
supply  stations  by  the  district  nurses  and  diagnos- 
ticians. These  orders  must  be  delivered  to  the  proper 
officials  in  the  Borough  Offices  on  the  same  night  im- 
mediately after  the  return  of  the  collectors  from  their 
rounds.  The  collectors  of  Brooklyn,  Bronx,  Queens 
and  Richmond  report  to  the  Diagnosis  Laboratory 
with  their  specimens,  as  follows : 

Brooklyn,    diphtheria    .  .1 8 :00  A.  M. 

Bronx,    all    specimens 8  :30  A.  M. 

Queens,   all   specimens 

Richmond,  all  specimens 

GENERAL  RULES  OF  DIAGNOSIS  LABORATORY. 

Sec.  317.  Only  workers  in  the  laboratory,  collec- 
tors, cleaners  and  officers  of  the  Bureau  are  allowed 

233 


in  the  laboratory.  All  others  must  receive  permis- 
sion from  the  Director  of  Bureau,  or  Assistant  Di- 
rector of  the  Laboratory. 

All  workers  in  the  laboratory  who  have  handled 
infected  material  of  any  kind  must  thoroughly  wash 
their  hands  with  soap  and  water  and  rinse  them  in 
1  to  1,000  bichloride  solution  before  leaving. 

No  waste  paper,  nor  wrappings  of  packages,  etc., 
are  to  be  tlirown  on  floor  or  desks.  Baskets  are  pro- 
vided. 

All  specimens  must  be  sterilized  as  soon  as  pos- 
sible after  preparation  of  slides,  etc.  [sputum  slips 
after  dating  and  numbering.] 

All  towels  are  to  be  kept  in  towel  clips  attached 
to  desks. 

All  instruments  and  materials  used  must  be  put 
away  neatly  at  the  conclusion  of  the  day's  work  and 
desks  and  glass  slabs  cleaned  with  5  per  cent,  car- 
bolic acid   (using  cheese  cloth,  not  towels). 

Each  employee  doing  microscopical  work  is  sup- 
plied with  a  microscope  for  his  personal  use.  He  is 
responsible  for  its  condition,  and  when  examinations 
are  finished,  must  wipe  oil  from  the  objective  witb 
lens  paper  (not  towels),  wipe  off  brass  and  lacquer, 
and  replace  instrument  in  his  locker  in  the  micro- 
scope cabinet,  turning  and  removing  the  key.  He  must 
replace  the  key  at  his  own  expense,  if  lost. 

White  suits  are  sent  to  the  laundry  every  Monday. 

One  bacteriological  diagnostician  must  be  con- 
stantly in  the  laboratory  between  9  A.  M.  and  5  P.  M. 

234 


P         MANHATTAN   COLLECTION   ROUTES. 

Sec.   318.  DAILY   EOUTES. 

I.    Bboadway  and  Sixth  Avenue  Route. 

P.M. 

Hegeman   St.  Nicholas  Ave.  &  180th  St. 4 :05 

Halper    Broadway  &  156th  St 4 :10 

Driesen    Broadway  &  144th  St 4 :15 

Dorb Broadway  &  127th  St 4:20 

Riker Broadway  &  110th  St 4:30 

Kerley    Broadway  &  102d  St 4 :35 

Tsheppe  &  Rieck Broadway  &  91st  St 4 :40 

Hegeman   Broadway  &  80th  St 4 :45 

Pond,  Bowes  &  Cart- 
wright   Broadway  &  70th  St 4 :50 

Boeddicker    ,.  .6th  Ave.  &  54th  St 5 :10 

Riker   6th  Ave.  &  28d  St .5 :35 

Bigelow    6th  Ave.  &  8th  St 5 :45 

Borough  Office 

m 

Ninth  Avenue  Route. 

Raub    ..St.  Nicholas  Ave.  &  145th  St.4 :00 

Molwitz    8th  Ave.  &  144th  St 4 :00 

Sagal  &  Kaufman... 8th  Ave.  &  135th  St 4:05 

Hegeman    8th  Ave.  &  12oth  St 4 :10 

McCutchen   8th  Ave.  &  113th  St 4:15 

Reed    ..( ....Columbus  Ave.  &  104th  St.. 4:20 

Taylor Columbus  Ave.  &  92d  St 4:25 

Buck    Columbus  Ave.  &  92d  St 

Spangenberg   Columbus  Ave.  &  82d  St 4 :30 

Bauer    Columbus  Ave.  &  69th  St... 4:40 

Jones  &  Leonard.... Columbus  Ave.  &  61st  St 4:45 

Roosevelt  Hospital.. Columbus  Ave.  &  59th  St... 4:50 


I 


23.5 


P.M. 

James   Stli  Ave.  &  44th  St 5:00 

Blomeier   9tb  Ave.  &  34th  St 5:10 

Golding   9th  Ave.  &  22d  St 5:20 

Katz  , 9th  Ave.  &  14th  St .5:25 

Flower    Hudson  &  Barrow  Sts 5 :35 

Knapp    Hudson  &  King  Sts 5 :40 

Herzenberg    40  Grand  St.,  nr.  Thompson . 5 :50 

Borough  Office 

Madison  and  Foukth  Avenue  Route. 

Robbins Lenox  Ave.  &  137th  St 4 :00 

Hegeman    Lenox  Ave.  &  125th  St 4 :10 

Diamond Lenox  Ave.  &  114th  St 4:15 

Perla    i. . .  .i.  Madison  Ave.  &  109th  St 4 :20 

MtSinai  Dispensary  .Madison  Ave.  &  100th  St 4:25 

Simetz Madison  Ave.  &  97th  St 4 :25 

Dauscha   .Madison  Ave.  &  91st  St 4:30 

Cassebeer ^ladison  Ave.  &  75th  St.... 4:40 

Timmermann Park  Ave.  &  65th  St 4:50 

Kalish Madison  Ave.  &  59th  St 4:5.5 

Munsch,  Protzman  & 

Co Madison  Ave.  &  48th  St 5:00 

Reeder ^ Madison  Ave.  &  48th  St 5:00 

Schoonmaker Park  Ave.  &  42d  St 5:05 

Caswell,  Massey  Co.. 4th  Ave.  &  33d  St 5:10 

Bagoe    4th  Ave.  &  29th  St 5 :15 

Kalish  4th  Ave.  &  23d  St 5:20 

Borough  Office 

Thibd  Avenue  Route. 

Budelman   Madison  Ave.  &  131st  St 4  :00 

Sayer    .  .i 125th  St.  &  3d  Ave 4 :05 

Trau 116th  St.  &  3d  Ave .4 :10 

Aronstamn 3d  Ave.  &  105th  St 4 :15 

23G 


P.M. 

Frohwein   3d  Ave.  &  91st  St '.  .4 :25 

Lascofe    Lexington  Ave.  &  83d  St . .  .4 :35 

Zinckgraf i 3d  Ave.  &  67th  St 4 :45 

iVauheim  Lexington  Ave.  &  oQtli  St. .  .4 :50 

Edlich   3d  Ave.  &  52d  St 4  :55 

The  Goldlust  Pharmacy 

3d  Ave.  &  88th  St 3 :45 

Du  Gay i Lexington  Ave.  &  34th  St. .  .5:10 

Keating    3d  Ave.  &  29th  St 5 :15 

Sultan .3d  Ave.  &  23d  St 5 :20 

(Valters 2d  Ave.  &  13th  St 5 :25 

^emser  1st  Ave.  &  5th  St ..5:30 

Borough  Office  ..... 

LowEK  East  Side  Route. 

Miner Spring  St.  &  Bowery 4:00 

tValker  Broome  &  Ludlow  Sts 4 :10 

.ja.  Pinto   Grand  &  Mott  Sts A  :15 

Juarini  &  Candela..New  Bowery  &  Roosevelt. .  .4:30 

liipset   , Henry  &  Pike  Sts 4:35 

ilamelok E.  Broadway  &  Clinton  St.  .4:40 

decker    Broome  &  Cannon  Sts 4 :50 

Joldblatt   E.  Houston  &  Cannon  Sts . .  .4  :.55 

xoldberg • ,. ..E.  Houston  &  Clinton  Sts... .5:00 

lobinson 10th  St.  &  Avenue  C 5 :15 

Veiss    9th  St.  &  2d  Ave 5 :25 

Jullenbach    . .( .  .4th  Ave.  &  Astor  PI 5 :30 

Borough  Office 

Sunday  and  Holiday  Route. 

I.    West. 

Ie;?eman    180th  St.  &  St.  Nicholas  Ave. 3 :00 

lalper    Broadway  &  156th  St 3:10 

237 


P.M 

Dorb    Broadway  &  127th  St 3:2< 

Riker Broadway  &  110th  St 3:21 

Reed    Columbus  Ave.  &  104th  St.  .3:31 

Spangenberg   Columbus  Ave.  &  82d  St. . .  .3 :4{ 

Bauer    Columbus  Ave.  &  69th  St. .  .3 :5I 

Dougan  &  Merritt.  ..Columbus  Ave.  &  61st  St... 3:5 

James    .  .8th  Ave.  &  44th  St. 4 :0! 

Goldmg    ,. . .  .,.9th  Ave.  &  22d  St 4  :li 

Riker 6th  Ave.  &  28d  St 4:2( 

Bigelow    6th  Ave.  &  8th  St 4:i 

Knapp , Hudson  &  King  Sts ,.  A: 

Herzenberg    Grand  St.,  nr.  Thompson . .  .4  :& 

Borough  Office 

II.    East. 

Raub   St.  Nicholas  Ave.  &  145th  St. 3 :0 

Sagal  &  Kaufman. .  .8th  Ave.  &  135th  St 3:1 

Hegeman    8th  Ave.  &  125th  St 3:1 

Hegeman    Xenox  Ave.  &  125th  St 3:2 

Sayer   125th  St.  &  3d  Ave 3:2 

Trau    3d  Ave.  &  116th  St.. 3:3 

Aronstamn  8d  Ave.  &  105th  St 3:3 

Lascofe    83d  St.  &  Lexington  Ave... 3:4 

Zinckgraf   ,. . .8d  Ave.  &  67th  St 3:5 

Lourle  &  Stoller 59th  St.  &  Lexington  Ave..4K) 

Kalish , Madison  Ave.  &  59tb  St 4  :C 

Schoonmaker 42d  St.,  nr.  Park  Ave 4:1 

Caswell  &  Massey  Co.4th  Ave.  &  33d  St 4 :2 

Kalish ) 4th  Ave.  &  23d  St 4:2 

Miner    „,. Spring   &   Bowery ,..4:; 

Mamelok E.  Broadway  &  Clinton  St.. 4:4 

Goldblatt    E.  Houston  &  Cannon  Sts..4:E 

Walter    2d  Ave.  &  13th  St 5:C 

Borough  Office  ..... 

238  M 


\A 


H 


'e 


It 


BRONX  COLLECTION  ROUTES. 

Sec.  319.  DAILY. 

I.    West. 

)epartment  of  Health  P.  M. 

Tuberculosis  ClinicE.    139tli   St.   &   New   Brook 

Ave 4:00 

•Icker  138tii  St.  &  Brown  PI 4:05 

>itarro   • 590  Morris  Ave.,  bet.  loOth  & 

151st  Sts 4:10 

Vurm   .....Morris  Ave.  &  162d  St 4:25 

)ibella .Plimpton  &  Boscobel  Aves.  .4 :40 

losenbaum    Fordbam  Rd.  &  Jerome  Ave. 4 :55 

ones   1 Fordham  Rd.  &  Marion  Ave .  5  :(J5 

lassell   Webster  Ave.  &  200th  St . . .  5  :15 

i^incke    ..White    Plains    Ave.    &    Gun 

Hill  Rd .5:25 

liller    E.  177th  St.  &  Park  Ave 5 :45 

ironx  Office,  Depart- 
ment of  Health... 3d  Ave.  &  St.  Paul's  PI 5:55 


I 


II.    East. 


ierson   .. ., 78  Westchester  Sq 4  :00 

filler Boston  Rd.  &  E.  177th  St... 4:15 

larass    Hoe  &  Freeman  Sts 4 :25 

L-Re-Co.  Pharmacy. .  Westchester  Ave.  &  Simpson 

St 4:35 

lothman    Westchester  &  Tinton  Aves. 4:45 

Joldwater    3d  Ave.  &  142d  St 5:00 

legeman    , 3d  Ave.  &  149th  St 5 :05 

Vernert    1272  Boston  Rd.  ( McKinley 

Square)     5 :35 

5ames   3d  Ave.  &  161st  St.., ...5:40 

239 


IB 


••^11 


Jl 


ll' 


Ir 


Huther   , 3d  Ave.  &  169th  St 5  :^  "^ 

Bronx  Office,  Depart-  '^ 

ment  of  Health... St.  Paul's  PI.  &  Sd  Ave 5:E 

m 

Sunday  and  Holiday  Routes. 

Miller    . ., Park  Ave.  &  E.  177th  St. . .  .3:4 

Rosenbaum    Fordham  Rd.  &  Jerome  Ave. 4^ 

Jones .Fordham  Rd.  &  Marion  Ave. 4: 

I'incke Gun  Hill  Rd.  &  White  Plains 

Ave 4:2 

Pierson Westchester  Sq , 4:1 

Miller    . ., Boston  Rd.  &  E.  177th  St. .  .5 

A-Re-Co.  Pharmacy.. Westchester  Ave.  &  Simpson 

St .5:3 

Rothman Tinton  &  Westchester  Aves.5:S 

Hegeman    149th  St.  &  3d  Ave 5 :? 

Sames  161st  St.  &  3d  Ave 5:4 

Huther    169th  St.  &  3d  Ave 5:t 

Bronx  Office,  Depart- 
ment of  Health... 3d  Ave.  &  St.  Paul's  PI 6:C 

BROOKLYN   COLLECTION   ROUTES. 

See.  320.  daily. 

Route  No.  1. 

Whitley 91st  St.  &  3d  Ave 4:( 

Wolf .69th  St.  &  3d  Ave 4:1 

Osborn    54th  St.  &  5th  Ave 4 :2 

Osborn    46th  St.  &  3d  Ave 4:5 

Cantor   337  Van  Brunt  St 4:4 

Kemble   Carroll  &  Henry  Sts ,...4:S 

Nehrbas    , 316  Court  St 5:C 

Raid 300  Clinton   St 5:C 


240 


JA 


P.M. 

aydenreich    167  Atlantic  Ave 5 :15 

imb , 84  Court  St , 5:20 

Iker 264  Fulton  St 5:25 

Bid   135  Sands  St 5:35 

apartment  of  HealthFleet  &  Willoughby  Sts 

Route  No.  2. 

ammond    ...73d  St.  &  13tli  Ave 4:00 

^ahlstadt   86tli  St.  &  18th  Ave 4 :10 

iwler    1401  60tli  St.  (Mth  Ave.) . .  .4 :25 

alke  Bros 53d  St.  &  13th  Ave 4 :30 

oamer , 39th  St.  &  Ft.  Hamilton  Ave. 4 :50 

all  &  Co 5th  Ave.  &  19th  St 5:10 

sborn    11th  St.  &  5th  Ave. ., 5 :20 

bramson  Drug  Co.  .President  St.  &  5th  Ave. . .  .5 :30 
apartment  of  HealthFleet  &  Willoughby  Sts 

Route  No.  3. 

jrager 757  Gravesend  Ave 4 :00 

ncelin  Surf  Ave.  &  W.  16th  St 4 :30 

eiss  310  Neptune  Ave.,  Coney  Isl.4 :40 

Dhnston E.  14th  St.  &  Kings  Highway .4 :5.5 

randenberg  Coney  Island  Ave.  &  Cortel- 

you  Rd 5:05 

aymow Beverly  Rd.  &  Coney  Island 

Ave 5:10 

respect  Drug  Co.  ..Prospect  Ave.,  cor.  Reeve  PI. 5:20 

ordon    15th  St.  &  7th  Ave 5:35 

oulsen 9th  St.  &  7th  Ave 5:40 

'epartment  of  HealthFleet  &  Willoughby  Sts 

Route  No.  4. 

Mlberger  540  Flatbush  Ave 4:00 

jiutler  883  Flatbush  Ave 4:05 

241 


1  P.M 

Hill    1098  Flatbush  Ave 4:1.E 

Hunter    1538  Flatbush  Ave 4t:2l 

Rappaport   1733  Nostrand  Ave 4 :3E 

Waif  ram 1292-94   Nostrand  Ave 4:4E 

Dannliardt .Rogers  Ave.,  cor.  Midwood  St.4 :5E 

Bancroft  712  Nostrand  Ave 5:1C 

Bancroft  Bergen  St.  &  Franklin  Ave.  .5 :15 

Wilson    etli  &  Flatbush  Aves 5 :25 

Vinnicombe   44  Flatbush  Ave 5 :3.5, 

Department  of  HealthFleet  &  Willoughby  Sts 

Route  No.  5. 

Quasman    ...Fulton  St.  &  Crescent  Ave. .4:00 

Chamberlain  &  Co... 3079  Fulton  St 4: 

Mindel    2789  Atlantic  Ave 4:15 

Werner 2592  Atlantic  Ave 4:20 

Katz    , Pitkin  Ave.  &  Chester  St 4:30 

Benjamin Fulton  St.  &  Rockaway  Ave. 4:50 

Balzheiser   Fulton  St.  &  Saratoga  Ave.  .5 :00 

Rohrer  Drug  Co.... Sumner  Ave.  &  Decatur  St.. 5:10 

Cadman    Tompkins  Ave.  &  Fulton  St.5 :15 

Pfister  &  Setterley.  .1293  Fulton  St 5 :20 

Malkovsky Fulton  St.  &  Wash'ton  Ave.5 :30 

Marsland   19  Greene  Ave 5 :3.5 

Department  of  HealthFleet  &  Willoughby  Sts 

Route  No.  6. 

Wesch   Wyckofif  &  Myrtle  Aves 4 :00 

Claassen    Myrtle  &  Knickerbocker  Avs .  4 :05 

Wendler Palmetto  St.  &  Central  Ave.4 :10 

Heimerzheim 567  Central  Ave 4 :15 

Stein   Broadway  &  Halsey  St 4:20 

Weber    Broadway  &  Gates  Ave 4 :30 

Probst Ralph  Ave.  &  Halsey  St 4 :35 

242 


P.M. 

ettle    895  Gates  Ave 4:40 

ayden  ...1189   Broadway    4:50 

cheidt   948-52  Broadway   5 :00 

ussensehidt  Bedford  &  Myrtle  Aves 5 :15 

;iopsch    Cumberland     St.    &     Myrtle 

Ave 5:25 

epartment  of  HealthFleet  &  Willoughby  Sts 

Route  No.  7. 

rmsburg  Drug  Co..S.  4tli  St.  &  Bedford  Ave... 4:05 

ossler  &  Hauck N.  6tb  St.  &  Driggg  Ave 4:10 

>pper 937  Manhattan  Ave 4 :20 

<awrence 764  Manhattan  Ave 4 :25 

^esoaldis Graham  Ave.  &  Jackson  St.  .4  :30 

'russ  Hamburg  Ave.,  cor.  Noll  St. 4 :40 

Jossong    Flushing  Ave.  &  Sumner  PI .  .4 :45 

Cempf    Broadway  &  Lorimer  St 4:50 

Yenzel  Co , 384  Broadway 5 :00 

)iehl  Bros 644  Bedford  Ave 5  :05 

)epartment  of  HealthFleet  &  Willoughby  Sts 

Sunday  and  Holiday  Routes. 

Route  No.  1. — Noeth  of  Fulton   Stbeet. 
V'msburg  Drug  Co..S.  4th  St.  &  Bedford  Ave... 4:00 

jawrence  764  Manhattan  Ave 4 :10 

Scheldt  969  Broadway  4:30 

Veber    Broadway  &  Gates  Ave 4 :35 

Verner   2592  Atlantic  Ave 4  :45 

ialzheiser    2040  Fulton  St 4  :55 

^fister  &  Setterley.  .1293  Fulton  St 5  :05 

-lalkovsky  Fulton  St.  &  Wash'gton  Ave. 5 :  10 

department  of  HealthFleet  &  Willoughby  Sts 

243 


Route  No.  2. — South  of  Fulton  Stbeet. 

P.M. 

Osborn    . ., 54th  St.  &  5th  Ave 4 :00 

Wolf    69th  St.  &  3d  Ave 4:05 

Wahlstadt    86th  St.  &  18th  Ave 4:20 

Spamer   39th  St.  &  Ft.  Hamilton  Ave. 4 :35 

Raymow   Beverly  Rd.  &  Coney  Island 

Ave 4 :45 

Cutler   . ., Church  &  Flatbush  Aves 4 :50 

Dilberger   540  Flatbush  Ave 5:00 

Wilson    6th  Ave.  &  Flatbush  Ave... 5:05 

Department  of  Health  Fleet  &  Willoughby  Sts 

QUEENS  COLLECTION  ROUTES. 

Sec.  321.  DAILY. 

Route  No.  1. — Nobth. 

Niemeyer  316-18  13th  St.,  College  Point.l  :30 

Lahey   i.87  Main  St.,  Flushing 1:55 

Hepburn 103  Main  St.,  Flushing 2:00 

Portugaloff    ........203     Corona     Ave.,     Corona 

Heights   2 :25 

Sloane   Corona,  24  Grand  Ave 2 :50 

Spaeth Elmhurst   3:05 

Zrubek    Lenox    &    Woodside    Aves., 

Wiufield  3:25 

Johnston    ..... .,. . .  .5th  St.,  nr.  L.  I.  R.  R.,  Wood- 
side   3:45 

Tewes    Broadway  &  Stein  way  Ave., 

Astoria   4 :10 

Collins    433  Stein  way  Ave.,  nr.  Grand 

Ave.,  Astoria  4 :25 

Scherer Stein  way  &  Flushing  Aves., 

Astoria    4 :40 

244 


li. 


P.M. 
Reilly   ....i. ...,...,.31  Flushing  Ave.,  cor.  Hallet 

St.,  Astoria 5 :00 

Dalcort 385  Jackson  Ave.,  L.  I.  City. 5:25 

Schnitzler Jackson  &  Vernon  Aves.,  L. 

I  I.  City  5:40 

Borough    Office,    De- 
partment of  HealthFulton  St.,  Jamaica 6 :30 

Route  No.  2. — South. 

'Lowe  Brothers Central  Ave.,  Far  Rockaway.l  :30 

Broadman    Maspeth   &   Clermont   Aves., 

Maspeth   3 :30 

Hill    .., I Cypress   Ave.    &   Ralph    St., 

Ridgewood    3 :55 

Sandman    1698  Myrtle  Ave.,  cor.  George 

St.,  Evergreen 4 :20 

Leavy    Jamaica  Ave.,   nr.   Oak    St., 

Richmond  Hill 4 :45 

Schmidt    1191  Jamaica  Ave.,  cor.  Suy- 

dam   St.,  Woodhaven 5 :05 

Lucas  &  Wilson. . . .  .3401  Jamaica  Ave.,  Richmond 

Hill   6:30 

Weiss    306  Fulton  St.,  Jamaica.... 6:50 

Borough    Office,    De- 
partment of  HealthFulton  St.,  Jamaica 6 :10 

Sunday  and  Holiday  Routes. 

Hepburn Flushing,  103  Main  St 2 :30 

Lahey   Flushing,  87  Main  St 2 :35 

Sloane  i Corona,  24  Grand  Ave 2 :55 

Spaeth Elmhurst    3 :10 

Zrubek    Winfield,  Lenox  &  Woodslde 

Aves. .8:20 

245 


P.M. 

Johnston Woodside,  5th  Ave.,  nr.  L.  I, 

R.  R 3:30 

Dolcort  . . .  .1 L.  I.  City,  436  Jackson  Ave.  .3.55 

Schnitzler ,...L.  I.  City,  Jackson  &  Vernon 

Aves 4 :05 

Hill   Ridgewood,   Cypress  Ave.  & 

Ralph  St 4:45 

Sandman    Evergreen,  Myrtle  Ave.,  cor. 

George  St 4 :55 

Leavy   » Richmond  Hill,  Jamaica  Ave., 

nr.  Oak  St 5:20 

Lucas  &  Wilson 3401  Jamaica  Ave.,  nr.  Myr- 
tle Ave.,  Richmond  Hill.. 5:25 

Weiss    Jamaica,  306  Fulton  St 5 :35 

Borough    Office,    De- 
partment of  HealthFulton  St.,  Jamaica 5 :40 

RICHMOND  COLLECTION  ROUTE. 

Sec.   322.  DAILY  AND   SUNDAY. 

James  Feeny Stapleton  3:50  : 

Herbert  J.  Lenz Rosebank  4:00 

Gustav  Schwab  ....Tompkinsville 4:15 

Sullivan   West  New  Brighton 4 :45  ; 

DeHart  Mariner's  Harbor 5 :00 

Fred  W.  Kerr Port  Richmond .5 :15 

Benson   . . .  .i New  Brighton  5 :35 

F.  E.  V.  BrandenbergNew  Dorp  (on  request) 6:00  ., 

Borough    Office,    De-  illf 

partment  of  HealthBay  St.,  cor.  Sand  St 6:00 

Cultures  may  be  left  for  incubation  after  6  P.  M. 
on  week  days  and  at  any  time  on  Sundays  and  holi- 
days at  the  Pharmacy  of  Lockwood  &  Colton,  91 
Water  Street,  Stapleton. 

246 


i 


BLANKS,    CIRCULARS,    ETC.,    ISSUED    BY    THE 
DIVISION   OF    COMMUNICABLE   DISEASES. 

Sec.  323.     (The  missing  numbers  are  no  longer  in 
use.) 

1  L.    Leaflet — Work  of  Diagnosis  Laboratory. 

2  L.    Book — Handbook  of  Help  for  Persons  Sufifer- 

ing  from  Pulmonary  Tuberculosis. 

3  L.    Blank — Inspectors'    and   Nurses'    Special   Re- 

port. 

4  L.    Card — Investigation  of  Weekly  Reports. 

5  L.    Card — Notice  to  Return  to   Clinic  for  some 

Special  Purpose. 

6  L.    Blank — Diphtheria  Culture  List. 

7  L.    Card — Clinic   Admission. 

8  L.    Circular — The    Association    of    Tuberculosis 

Clinics. 

9  L.    Leaflet — Regulations     Regarding     Reporting 

Cases  of  Tuberculosis. 

Envelope — Hospital  Admission  Bureau,  large. 

Card — Report  to  Borough  Office  from  Diag- 
nosis Laboratory  (Typhoid,  etc.) 

Blank — Notice  of  Park  Stereopticon  Exhibi- 
tions,  English. 

Blank — Weekly  Report  of  Division. 

Envelope — ^Typhoid  Filing. 

Blank — Supply  Station  Agreement. 

Card — Acknowledgment  of  Report  of  Case 
of  Tuberculosis.     (To  Physician.) 

Envelope — Hospital  Admission  Bureau,  Large 
Addressed. 

Folder— Clinic  Reference.     (A.  T.  C.) 

Letterhead — Hospital  Admission  Bureau. 

247 


20  L.    Envelope — Hospital        Admission        Bureau, 
Small. 

Blank — Primary  Diphtheria  Slip. 

Blank — Primary  Positive  Diphtheria  Report 

Blank — Primary  Negative  Diphtheria  Report. 

Letter — Deaths   from   Tuberculosis   Not   Pre- 
viously Reported  During  Life. 

Blank — Secondary  Diphtheria  Slip. 

Blank — Hospital  Diphtheria  Culture  List. 

Tuberculosis  Folder  (Spanish).  |l 

Envelope — Diphtheria   Filing. 

Card — For  Visitors  to  Riverside  Hospital. 

Blank — Hospital  Admission  Card. 

Circular — Mosquitoes  and  Malaria.  !(] 

Circular — Widal  Test  for  Typhoid  Fever.        <  • 

Card — Weekly  Report  of  Branch  Office. 

Blank — Daily  Tally  Sheet   (Tuberculosis). 

Card — Guide     Card     for     Southern     Italian 
Clinic. 

Blank — Sputum   Slip. 

Blank — Negative  Sputum  Report. 

Blank — Widal  Test.   Report. 

Blank — Notice  of  Park   Stereopticon  Exhibi- 
tions (Yiddish). 

Card — Reference  for  Charitable  Aid. 

Card — ^Tuberculosis  Case  History. 

Card — Requesting  Name  and  Address  of  Pa- In 
tient  (Sputum). 

Blank — Notice  of  Park   Stereopticon  Exhibi- 
tions (Italian). 

Blank — Nurses'    Report    of    Infectious    Dis-  • 
eases  with  Recommendation. 

Blank — Report  of  Result  of  Examination  for 
Treponema  Pallidum. 

248 


21  L. 

22  L. 

24  L. 

25  L. 

26  L. 

28  L. 

29  L. 

30  L. 

31  L. 

32  L. 

33  L. 

34  L. 

35  L. 

36  L. 

37  L. 

38  L. 

39  L. 

40  L. 

41  L. 

42  L. 

44  L. 

45  L. 

46  L. 

48  L. 

49  L. 

50 

L. 

.51 

L. 

52 

L. 

53  L. 

54  L. 

55  L. 

56 

L. 

57 

L. 

58 

L. 

59 

L. 

60 

L. 

61 

L. 

63 

L. 

Tuberculosis   Folder    (Armenian). 

Card — Acknowledgment  of  Report  of  Case  of 
Venereal  Disease. 

Blank — Notification   Regarding  Placards. 

Blank — Inventory  of  Forms. 

Second  Annual  Report  of  Clinics. 

Card — Notice  of  Removal  of  Placard. 

Blank — Later  Negative  Diphtheria  Report. 

Blank — Later  Positive  Diphtheria  Report. 

Card — Poliomyelitis  History. 

Blank — Supply  Requisition. 

Circular — Information  Regarding  Tuberculo- 
sis Clinics. 

Card — Cerebro-spinal   Meningitis    History. 

Card — Hospital  Vacancies. 

64  L.    Blank — Forcible  Removal  of  Case  of  Tuber- 

culosis. 

65  L.     Card — History     of     Discharged     Sanatorium 

Cases. 

66  L.     Circular — The  Sanitary  Supervision  of  Tuber- 

culosis by  the  Department  of  Health. 

67  L.     Blank — Letter   Requesting   Typhoid   Informa- 

tion. 
Card — Clinic,  Later  History. 
Card — Sanatorium  Report  of  Admissions,  etc. 
Blank — Day  Camp  Weekly  Report. 
Card — Reference  to  Otisville  Sanatorium. 
Circular — Consumption    Cures    (Italian). 
Blank — Daily   Record    of   All   Applicants    to 

Clinic. 

74  L.     Clinic  Prescription  Blanks. 

75  L.     Circular — Importance  of  Early  Diagnosis  of 

Tuberculosis. 

76  L.     Blank — Daily  Journal  Serological  Laboratory. 

249 


77  L.    Envelope — Clinic  History  Card. 

79  L.    Blank — Loose    Leaf    Grocery    Record,    Day 

Camps. 

80  L.    Card— Transfer  and  Receipt  of  Records. 

81  L.    Postal — Recommendation   of   Case   of   Tuber- 

culosis to  Charitable  Societies,  etc. 

83  L.    Card — Recommendation  for  School  Exclusion 

or  Admission. 

84  L.    Blank — Daily  Report,  Grocery  Supplies,  Day 

Camps. 

85  L.    Envelope — For  Otisville  Reference  Card. 

87  L.    Card — Medical  Report  on  Clinic  Case. 

88  L.    Placard — Sanatorium  Requirements  (same  as 

90L). 

89  L.    Blank — Daily  Report  from  Borough  OfBce — 

Tuberculosis. 

90  L.    Blank — Sanatorium   Requirements    (same   as 

88L). 

91  L.    Envelope — Large    Manila,    Addressed   to    Bu- 

reau of  Infectious  Diseases. 

92  L.    Envelope — Small    Manila    for   Clinic    Admis- 

sion Cards. 

93  L.    Card— Efficiency  Rating  Card. 

94  L.    Blank — Daily  Report  to  Borough  Office. 

95  L.    Card — Tuberculosis  House  Record. 

96  L.    Blank — Clinic  Urine  Report. 

97  L.    Blank — Report  of  Positive  Sputum  Examina- 

tion. 

98  L.    Blank — Nurses'  Weekly  Report  Record,  Loose 

Leaf. 

99  L.    Card — Tuberculosis  Clinic  Throat  History. 

100  L.    Envelope — Small,    Department,    Addressed. 

101  L.    Card — Information  for  Physicians,  Regarding 

Admission  Bureau. 

250 


Card — Clinic  Primary  History. 

Circular — Work  and  Products  of  Laboratories 
of  Department  of  Health. 

Blank— Typhoid  Fever  Widal  Test  Slip. 

Tuberculosis  Folder  (Finnish). 

Card — Inspectors'   Daily   Report 

Envelope — Hospital  Admission  Bureau  Rec- 
ord. 

Card — Hospital  Admission  Bureau  Record. 

Blank — Clinic  Weekly  Report  Record,  Loose 
Leaf. 

Paster — Tuberculosis :     Disinfection. 

Envelope — Large — Department,   Addressed. 

Envelope — Record  of  Printed  Forms. 

Envelope — Record  of  Bills  and  Requisitions. 

Card — Result  of  Examination  of  Baker. 

Card — Supply  Station  Record. 

Postal — Information  About  Horses,  Glanders. 

Blank— Glanders  Outfit  Slip. 

Book — ^What  We  Should  Know  About  Tuber- 
culosis. 

125  L.    Circular — Acute   Poliomyelitis — for   the   Pub- 

lic. 

126  L.     Card— Tuberculosis  Tally. 

127  L.    Card — Reference  to  Boat  Camps. 

128  L.   Card— To  Call  at  Hospital  Admission  Bureau. 

129  L.     Card — Acknowledgment    of    Report    of    Case 

of  Typhoid  Fever  or  Meningitis. 

130  L.     Handbill     Pads— For     Distribution     to    Vio- 

lators of  the  Law  Against  Spitting. 

131  L.    Blank — Letterhead  of  the  Bureau. 

132  L.    Blank — Clinic  Drug  Inventory,  Loose  Leaf. 

133  L.    Tuberculosis  Folder  (Polish). 

134  L.    Tuberculosis  Folder  (Slovak). 

251 


135  L.    Tuberculosis  Folder   (Ruthenian). 

136  L.    Hanging  Card — Prevention  of  Typhoid  Fever 

(Yiddish). 

137  li.    Circular — Acute     Poliomyelitis — for     Physi- 

cians. 

138  L.    Envelope — Sputum  Filing. 

139  L.    Folder — ^Advice    for    Patients    (German-Eng- 

lish). 

140  L.    Card — Private  Physician,  Later  Tuberculosis 

Report  Card. 

141  L.    Card — Clinic  Reference  Card. 

142  L.    Blank — Superintendent     of    Nurses'     Weekly 

Report. 

143  L.    Envelope— Widal  Outfit. 

144  L.    Card — Home  Conditions  of  Hospital  Patient. 
14,5  L.    Postal — Druggist's  Station   Supplies. 

147  L.    Folder — ^Advice    for    Patients    (Yiddish-Eng- 

lish). 

148  L.    Card — Druggist's     Requisition     for     Station 

Supplies. 

149  L.    Card — Tuberculosis  Clinic  House  Card. 

150  L.    Card — Delinquent  Clinic  Case. 

151  L.    Blank — ^Weekly   and    Monthly    Clinic   Report 

Record  (Loose  Leaf). 

152  L.    Monograph — Report   on   Registration   of   Tu- 

berculosis. 

153  L.    Card— Daily  Report  of  Branch  Office  to  Hos- 

pital Admission  Bureau. 

154  L.    Blank — Monthly  Statement  of  Drugs. 

155  L.    Folder— Advice    for     Patients     (Italian-Eng- 

lish). 

156  L.    Blank— Clinic  Weekly  Report. 

157  h.    Blank — ^Renovation    Request. 

252 


Card — Clinic  Physician's  Report  on  Trans- 
ferred Case.   (A.  T.  C.) 

Blank — Typhoid  Diazo  Slip. 

Envelope — Typhoid  Diazo  Filing. 

Blank — Typhoid  Diazo  Report. 

Tuberculosis  Folder  (Chinese). 

Blank — History  Form  for  Syphilis. 

Circular — Venereal  Disease. 

Blank — Malaria  Report. 

Blank — Malaria  Slip. 

Envelope — Malaria  Filing. 

Envelope — Venereal  Disease  Filing. 

Blank — Notice  to  Physicians  Regarding  Ad- 
vice to   Venereal   Disease  Patients. 

Circular — Information  on  Vaccination  on 
Smallpox. 

Blank — Weekly  Report  of  Division  of  Ty- 
phoid Fever. 

Blank — Important  Information  Regarding 
the  Wassermann  Reaction  for  Syphilis. 

Card — Leaky   Sputum    Specimen. 

Card — Reference  of  Case  to  Hospital. 

Card — History  of  Fatal  Case  of  Malaria. 

Leaflet — Rules  for   Sweeping    (German). 

Leaflet — Rules  for  Sweeping  (Italian). 

Hanging  Card — Prevention  of  Typhoid  Fever 
(English). 

Blank — Reference  Slips. 

Blank — Result  of  Complement  Fixation  Test. 

Blank — Letters  to  Physician  Regarding  De- 
lay in  Reporting  Typhoid  Fever  Cases. 

Blank — Result  of  Wassermann  Test. 

Blank — Infectious  Diseases;  Ward  List. 

Card — Typhoid  History. 

253 


186  L. 

187  L. 

188  L. 

190  L. 

191  L. 

192  L. 

193  L. 

194  L. 

195  L. 

196  L. 

197  L. 

198  L. 

200  L. 

201 

L. 

202 

L. 

203 

K 

204 

L. 

205 

L. 

206 

L. 

207 

L. 

208  L. 

185  L.    Blank — Daily  Report  of  Communicable  Dls 

eases. 

Envelope — Meningitis  Filing. 

Blank — Meningitis  Report. 

Blank — Meningitis  Slips. 

Blank — Weekly   Report   of    Hospital    Admis- 
sion Bureau. 

Card — Report  of  Cases  of  Venereal  Disease. 

Blank — Weekly  Report,  Diagnosis  Laboratory. 

Blank — Diagnosis  Laboratory  Daily  Borough 
List. 

Card — Collectors'  Receipt  Card. 

Envelope — Diphtheria  Culture  Tube. 

Circular — Meningitis  Information. 

Blank — Certification   Slips  for  Bills. 

Hanging  Card — Prevention  of  Typhoid  Fever 
(Italian).  \: 

199  L.    Blank — Result  of  Complement  Fixation  Test 
for  Gonococci. 

Leaflet — Rules   for   Sweeping    (Yiddish). 

Card — Clinical     Laboratory     Report   (Urine,  . 
etc.). 

Handbook  of  Bureau  of  Infectious  Diseases,  tj 

Card — Waiting  List  Card. 

Card — Waiting  List  Notification. 

Card — Diphtheria   Virulence  Test. 

Booklet — Infectious     Diseases,     and     Supply 
Stations. 

Card — Appointment  with  Dentist. 

Blank — Weekly    Report — Tuberculosis    Insti- 
tutions— First   Sheet.  jj 

209  L.    Blank — Daily    Report— Tuberculosis    Institu- " 

tions. 

210  L.    Card — Hospital  Temperature  Record  Charts. ijs 


254 


i 


Card — Clinic  Diagram  Card. 

Card— Clinic  Sputum,  etc. 

Blank — Result  of  Complement  Fixation  Test 
for  Glanders. 

Blank — Report  of  Physician  Regarding  Tu- 
berculosis Patient. 

Blank — Letter  to  Physician  Regarding  Tu- 
berculosis Patient. 

Folder — Information  Regarding  Contagious 
Diseases  for  School  Children. 

Double  Postal — Delinquent  Clinic  Cases. 

Blank — Clinic  Daily  Journal,  Loose  Leaf. 

Blank — Gonococcus  Slip. 

Blank — Gonococcus  Report. 

Blank — Weekly  Report  Division  of  Institu- 
tion Inspection. 

Card — Instruction  to  Those  Having  Gonor- 
rhoea. 

Card — Instruction  to  Those  Having  Syphilis. 

Hanging  Card — Dispensary  Placard. 

Booklet — Notification  of  Acceptance  for  Otis- 
ville  Sanatorium. 

Card — Delivery  and  Acceptance  of  Goods. 

Circular — Warning  Against  Consumption 
Cures    (English). 

Blank — Weekly  Report  of  Borough  Chief. 

Tuberculosis  Folder    (English). 

Card — Fumigation. 

Blank — Direction  for  Drawing  Blood  for 
Complement  Fixation  Test. 

Card — Final   Report   on   Glanders. 

Blank — History  Form  of  Treponema  Palli- 
dum Examination. 

Tuberculosis  Folder    (Swedish). 

255 


237  L.    Blank — Physicians'  Receipt  for  Wassermann'' 

Outfit. 

238  L.    Tuberculosis  Folder   (Italian). 

239  L.    Tuberculosis  Folder  (Bohemian). 

240  L.    Tuberculosis  Folder  (German). 

241  L.    Tuberculosis  Folder   (Yiddish). 

242  L.    Card — ^Tuberculosis  Clinic  Name  Index. 

243  L.    Blank— Carfare  Bill  Head. 

244  L.     Blank— Carfare  Bill,  Second  Sheet. 

245  li.    Card — Record  of  Antityphoid  Immunizations. 

246  L.    Pamphlet  —  Tuberculosis      Catechism      for 

School  Children. 

247  L.    Blank — Request     for     Name     of     Physician 

(Sputum). 

248  L.    Card— Dog  Bite  History. 

249  L.    Hanging  Card — Hospital  Placard. 

250  L.     Circular — Information   Regarding   Immuniza-; 

tion  Against  Typhoid  Fever.  I 

251  L.    Card — Investigation    of    Hospital    Convales-l 

cent. 

252  L.     Card — Investigation   of   Milk   Supply  —  Ty- 

phoid Fever. 

253  L.     Envelope — Large  Manila. 

254  L.     Blank — Bureau  of  Weekly  Report  Serological 

Laboratory. 

255  L.     Blank — Bureau     Weekly     Report     Record- 

Loose   Leaf. 

256  L.     Card— Dental  History. 

257  L.    Blank — Weekly  Report  Tuberculosis   Institu- 

tions of  the  Department  of  Health.    Sec- 
ond Sheet. 

258  L.     Booklet — Formulary      of      the      Tuberculosis 

Clinics  of  the  Department  of  Health. 

259  L.    Card— Nurses*  Daily  Report. 


256 


11 


Envelope — Tuberculosis  Record  Filing. 

Blank — Sanatoria  and  Clinic  Sputum  Slips. 

Hanging  Card — Dispensary  Typhoid  Placard. 

Card — Report  to  Branch  Office  of  Case  not 
Found. 

Card — Central  Borough  File,  Tally  Card. 

Blank — ^Report — Unsatisfactory  Later  Diph- 
theria Culture. 

Card — Request  for  Information  on  Trans- 
ferred Tuberculosis  Case. 

Card — Nurses'  Later  History. 

Blank — Clinic  Tabulation  Sheet. 

Placard — Stereopticon  Exhibits. 

Hanging  Card — How  to  Keep  from  Getting 
Contagious    Diseases    (English-Yiddish). 

Hanging  Card — How  to  Keep  from  Getting 
Contagious  Diseases   (English-German). 

Hanging  Card — How  to  Keep  from  Getting 
Contagious  Diseases    (English-Italian). 

Placard — Whooping    Cough    Clinics. 

Card — Clinic  Reference  of  Baker. 

Blank — Weekly  Report  Veterinary  Section. 

Double  Postal — Delinquent  Clinic  Case 
(Italian). 

Card — Organization  Infectious  Disease  Pos- 
tal. 

Card — Information   about  Whooping  Cough. 

Card — Notice  of  Monthly  Conferences. 

Blank — Institution  Report  of  Infectious  Dis- 
eases for  Journal. 

Folder — Prevention  of  Typhoid  Fever  (Four 
languages). 

Placard — Hotel,  Boarding  House  and  Fur- 
nished Room  Placard. 

257 


BOUND  BECOBDS. 

IL.L.     Book — Fumigation  Journal. 

3  L.L.     Book — Daily  Telephone  Journal  of  Infection^ 

Diseases. 

4  L.L.     Book — Record  of  Personal  and  Foreign  Tele- 

phone Calls. 

Book — Daily  Journal  of  Bureau. 
Book — Hospital   Admission   Bureau   JournaLJ 
Book — Institution    Infectious    Disease    Jour- 
nal. 

Book — Executive  OflSce  Journal. 

Book — Record      of      Diagnosis      Laboratory^ 
Weekly  Report. 

24  L.L.    Book — Diagnosis    Laboratory    Carfare   Jour-| 
nal. 


6  L.L. 

8L.L. 

9  L.L. 

19  L.L. 

22  L.L. 

1  J. 

2  J. 

o  J. 

4  J. 

5  J. 

6  J. 

7  J. 

8  J. 

9  J. 

10  J. 

13  J. 

Card — Daily  Record  of  Contagious  Diseases. 

Card — Notice  of  Free  Distribution  of  Anti- 
toxin Syringe  Containers. 

Envelope — "Academy  of  Medicine." 

Card — Glanders  Placard. 

Postal — Report  of  Contagious  Diseases. 

Envelope— "Health  Officer  of  Port." 

Card — School  Certificate. 

Envelope — "Secretary  of  State  Board  of 
Health." 

Blank — Goods  for  Removal  for  Sterilization. 

Card — Diagnostician's  Removal  Card. 

Hanging  Card — Prevention  of  Mumps  (Eng- 
lish). 

258 


Postal — School  Exclusions. 

Blank — Result  of  Examination  of  Brain  of 
Dog. 

Blank — Report  of  Forced  in  Case. 

Blank — Inspector's  Report  of  Case  of  Con- 
tagious Disease. 

Circular — Information  About  Diphtheria. 

Card — History  of  Case  of  Infectious  Disease. 

Card — Consent  to  Destroy  Glandered  Horse. 

Blank — Application  for  Special  School  Certifi- 
cate. 

Blank — Daily  Report  from  Borough  Office — 
Contagious. 

Hanging  Card — Prevention  of  German  Measles 
(English). 

Card — Goods  Wagon  Driver's  Memorandum. 

Blank — Record  of  Goods  Removed  for  Steril- 
ization. 

Blank — Acknov^^ledgment  of  Receipt  of  Com- 
munication. 

Blank — Daily  Record  of  Goods  Removed  for 
Sterilization. 

Envelope — Dog  Bite  Envelope. 

Card — Information  Regarding  Dogs,  Head  for 
Examination. 

Postal — Acknowledgment  of  Report  of  Case  of 
Contagious  Disease. 

Blank — Removal  of  Case  by  Ambulance. 

Blank — Health  Squad  Detail. 

Envelope — Infectious  Disease  History  En- 
velope. 

Circular — Rules  Governing  Procedure  After 
Death  from  Contagious  Diseases. 

259 


42  J.    Blank— Daily  Tally  Sheet— Contagious. 

43  J.    Blank — Memorandum  for  Complaint. 

44  J.    Blank — Scarlet  Fever  Placard. 

47  J.     Blank — Diphtheria  Placard. 

48  J.    Hanging  Card — Prevention  of  Whooping  Cough 

(English). 

49  J.    Hanging  Card — Prevention  of  German  Measles 

(Yiddish). 

50  J.    Hanging  Card — Prevention  of  German  Measles 

(German). 

51  J.    Hanging  Card — Prevention  of  German  Measles 

(Italian). 

52  J.    Hanging   Card — Prevention  of   Mumps    (Yid- 

dish). 

53  J.    Hanging   Card — Prevention   of  Mumps    (Ger-^ 

man). 

54  J.    Hanging   Card — Prevention  of  Mumps    (Ital-; 

ian).  ' 

5.5  J.    Hanging  Card — Prevention  of  Whooping  Cough 

(Yiddish). 
58  Ji    Blank — Request  for  Destruction  of  Dog. 

60  J.     Hanging  Card — Prevention  of  Whooping  Cough 

(German). 

61  J.    Hanging  Card — Prevention  of  Whooping  Cough 

(Italian).  , 

64  J.    Hanging    Card — Prevention    of    Chicken-Pox! 

(Yiddish). 

65  J.    Hanging    Card — Prevention    of    Chicken-Pox 

(German). 

66  J.    Hanging    Card — Prevention    of    Chicken-Pox 

(Italian). 
68  J.    Hanging    Card— Prevention    of    Chicken-Pox 
(English). 


260 


11 


Envelope — Glanders  Envelope. 
Card — Glanders  Destruction  Card. 
Card — Glanders  Disinfection. 
Blank  —  Veterinarian's     Telephone    Report — 
Glanders. 
J.    Blank — Veterinarian's     Telephone    Report — 

Dogs. 
J.     Envelope — Small  Manila  Envelope. 
J.    Card — Order  for  Fumigation. 
J.     Card — Smallpox  History — Primary. 
J.    Card — Smallpox  History — Later. 
J.    Blank — Fumigation  Placard. 
J.    Blank — Private  Fumigation  Certificate. 
J.    Blank — Measles  Placard. 
J.    Blank — Diagnostician's  Telephone  Blank. 
J.    Blank — History  of  Case  of  Glanders. 
J.    Blank — Receipt  Slips  File. 
J.    Envelope — "For  Disinfector." 
J.    Card — Contagious  Disease  in  School  Children. 
J.     Card — Veterinarian's  Daily  Report. 
J.    Blank — Veterinarian's  Weekly  Report — Loose 
Leaf. 
Card — Disinfector's   Daily  Report. 
Blank — Disinfector's    Weekly    Report — Loose 

Leaf. 
Card — Health  Squad  Report. 
Card — Investigation    of   Case    of    Contagious 
Disease. 
80  J.    Card — Disinfection  Delayed. 

J.J.    Receipt  for  Goods  for  Disinfection  and  Sterili- 
zation. 

8  J.J.     Book — List  of  Goods  Collected — Disinfection. 


261 


FORMS  OF  OTHER  BUREAUS  EMPLOYED  IN' 

THIS  BUREAU  ALSO'. 
Sec.  324. 

6  A.     Blank — Letterhead  for  General  Use  by  De- 
partment. 

Blank— Time  Sheet 

Hanging     Card — Instructions     Warning! 
Against  Flies. 

Blank — Department  Requisitions. 

Blank — Statement     Accompanying     Invoice 
for   Supplies. 

Blank — Notification  of  Absence. 

Blank — Application  for  Leave  of  Absence. 

Blank — Counsel's  Notice  to  Compel  Renova- 
tion. 

Book — Goods  Wagon  Drivers'  Receipts. 

Blank — Renovation   Notice — Tuberculosis. 

Card — Physical  Record  of  Employees. 

Blank— Official  Seal  for  Caskets. 

Blank — Culture   Slips  Employed  by  Bureau 
of  Child  Hygiene. 
26  N.     Blank — Drivers'    Goods    List    to    Research! 
Laboratory. 
3  Y.     Blank — Requisitions  for  Drugs  for  Clinics. 


23  A. 

53  A. 

98  B. 

4  C. 

21  C. 

23  C. 

5  D. 

13  E.E. 

14  E. 

23  E. 

13  H.H. 

16  K. 

262 


nrDEx. 

•^  Section 

Abbreviations, — System    in    Tbc.    Clinics 207 

Abbreviations, — Of    Result    of    Cultures 291 

Absence    from    Duties 9 

Absence — Notification    of 11 

Acute    Ant.    Poliomyelitis — Procedures    in 83 

Administration    of   Anti-Rabic    Treatment 283 

Admission  to  Hospitals  for  Tbc 180 

Advertising    Venereal     Quacks 273 

Aid — Charitable, — in   Tbc.   Clinics 226 

Aid — Charitable, — in    Tbclar.    Cases 150 

Ambulance    Service 103,  104 

Ambulance    Drivers, — Duties 107 

Anterior   Poliomyelitis — Procedures   in 83 

Anthrax — Procedures     in 90 

Antiformin  Method   of  Sputum  Examination 305 

Antitoxin, — Diphtheria     75 

Antitoxin, — Where  sold  in   Syringe-Containers 76 

Applicants  to  Sanatoria,  through  Hosp.  Adm.  Bureau  185 

Applicants, — Instructions     190 

Applications   for  Admission   to   Institutions — Tbc...  175 

Appointments — Temporary 5 

Appointment    &   Promotion    of   "Volunteer   Attending 

Physician     232 

Assignments — Personal    Attention    to 30 

Assignments   of  Cases — Institution  Inspection 125 

Association  of  Tbc.   Clinics 237 

"At  Home"  Cases  of  Tuberculosis 141 

Attending   Physician — Rules   for 230 

Attending     Physician — Volunteer 231 

Attending  Physician — Appointment  «&  Promotion   of 

Volunteer    to     232 

Authorization   of   Sanitary   Supervision  by   Sanitary 

Code     4 

Auxiliary    of    Tbc.    Clinics — Women's 236 

B 

Badges     29 

Bakers'   Examinations    210 

Blanks,    Records,    Etc 35 

Books, — Their    Disinfection 97 

Borough-Chief, — Duties     26C 

Borough   Diagnostician 51 

Borough  Offices, — See    Directory    2 

Borough  Office — General     Procedure     in     Infectious 

Diseases   in    37,  44 


I 


263 


Section 
Borough  Office, — Notification  &  Registration  of  Ty- 
phoid        243 

Borough  Office, — Organization  for  Tbc.  Work 128B 

Borough  Office, — Records  of  Infectious  Diseases...  40 
Boroughs  Outside  of  N.  Y. — Cases  of  Tbc.  living  in  147 
Branch  Office, — ^Daily  Reports  to  Borough  Office...  47 
Branch  Office, — ^Daily    Reports    to    and    from    Tbc. 

Clinics     202 

Branch  Office, — Notification    &    Registration    in    Ty- 
phoid        244 

Branch  Office, — Procedures    in    Tbc 130 

Branch  Office, — Records    Infectious   Diseases 41 

Branch   Office, — System    of    Registration,    Infectious 

Diseases     42 

Burial  Regulations    in    Infectious    Diseases 4L 

Burial  Required   in   24   hours 4N 

Bureau  of    Infectious    Diseases, — Functions 1 

Bureau  of  Infectious  Diseases, — Organization 3 

Bureau  of      Information      of     Hospital     Admission 

Bureau     186 

Business — Completed  Daily  in   Offices 15 

C 

Camps, — See   Directory 2 

Camps  &  Fresh  Air  Schools  (Tbc.) 19 

Camp — Nurses v . . . .    193 

Camp     Regulations 194 

Camps — Routine  Procedure  in 192 

Card, — (History)     in    Tbc 165 

Card — Name    File    for    Tbc 60E 

Care  for  families  of  Tbc.  patients  in  Hospital 152 

Care  of  Department  Property 18 

Carfare  &   Telephone   Bills 31 

Carriers, — ^Diphtheria     78 

Census — for   Tbc.   Cases    (Monthly) 133 

Central   Filing   Bureau 24 

Cerebro-Spinal  Meningitis — Laboratory  Examination 

for     313 

Cerebro-Spinal  Meningitis — Procedures  in 82  |i 

Charity     Organizations, — Notifying     of     Infectious 

Diseases     38B 

Charitable  Assistance    &    Education    of    Public    in 

Contagious   Diseases    62 

Charitable  Aid  Recommendation    in    Tbc 150 

Charitable  Aid  in    Tbc.    Clinics 226 

Charts   &   Tabulations, — Typhoid 240  ! 

Chicken   Pox — ^Procedures    in 87 

264 


Section 

Chief  Clerks, — Duties    32 

Chief  Diagnostician    50 

Chief  of  Division  of  Contagious  Diseases 49 

Chief  of  Division, — Typhoid     Fever ( 239 

Chiefs    of   Division, — Duties 26B 

Chief  of  Venereal  Disease  Division 260 

Children — T|Uberculosis     in 167 

Children — Preventorium     for 187 

Cholera — Procedure    in 30 

Circulars  of  Information, — Diagnostic    "Laboratory.   288 
Circulars  of  Information, — Diphtheria    Cultures    ...   301 

Circulars  of  Information, — The.     Clinic ,'.    235 

Circulars  to  Tbc.     Clinic    Patients 219 

Circulars  of  Information, — Venereal  Diseases 274 

Circulars  of  Information, — Widal  &  Diazo  Reaction.   311 

Circulars  of  Instruction, — Home    Cases   of   Tbc 162 

Classification  of  Tbc.   Cases 135 

Cleaners    &    Scrubwomen    in    Tbc 159 

Clinics — See   Directory    2 

Clinics — Administration  of  Anti-Rabic   Treatment..    283 

Clinics — (Diagnostic),  for  Venereal  Diseases 265 

Clinic    Abbreviations     (Tuberculosis) 217 

Clinics   (Tuberculosis), — ^Applicants  from  other  dis- 
tricts       208 

"  "  Appointments      &      Promo- 

tions of  Vol.  Attd.   Phys.   232 
"  "  Association  of  Tbc.  Clinics  237 

Charitable  Aid   226 

"  "  Circular, — Instructions      to 

Patients     / ,.   219 

"                      "                    Circular    of    Information..   235 
"                      "                    Confirmatory     Re-examina- 
tions        218 

"  "  Daily  Reports  to  and  from 

Branch    Offices    202 

"  "  Deaths   from   Tbc 215 

"  "  Delinquent    Cases     223 

"  "  Eggs    and    Milk 229 

"  "  Examination    of    Bakers...    210 

"  "  Examination    for    Peddler's 

License     211 

"                      "                    Final  Diagnosis  (Later  Ex- 
aminations)      225 

'♦  "  Forwarding    Reports 201 

"  "  Furniture,  Signs,  Maps,  etc.  200 

Home    Visits    by    Nurses..   222 


% 


265 


Section 
Clinics    (Tuberculosis), — Home  Visits  by  Clinic  Phy- 
sicians         22S 

**  "  Instructions      to      Patients 

(Circular)     219 

**                      "                    Instructions  in  history  tak- 
ing        206 

"  "  Medicines     220 

"  "  Milk    and    Eggs 229 

"  "  Non-tubercular    Applicants  209 

"  "  Objects    of     196 

"  "  Organization     199 

"  "  Physicians    in    charge    of .  .   198 

"  "  Procedures    in   Clinics 195 

"  "  Procedure    in    Examination 

Rooms     216 

"  "  Procedure   in   Deaths   from 

Tbc 215 

"  "  Recommending   Hosp.    Care  212 

"  "  Relief    Committees    227 

"  "  Reports  to  Headquarters..    203 

"  •*  Reporting  New   Cases 214 

"  "  Routine    Procedure    205 

"                      "                    Rules    for    Clinic   Nurses,.    234 
"                      "                    Rules  for  Attending  Physi- 
cians         230 

"                     "                   Sputum    and    Urine    Speci- 
mens         213 

Staff     197 

"  "  Statistics   tabulated    204 

••  "  Study   of   Cases 224 

•*  "  System  of  Filing  Histories  207 

"  "  System   of  Abbreviations..    217 

"  "  Tabulation    of    Statistics. .  .   204 

"  "  Throat    Examinations 221 

**                      "                    Urine    and    Sputum   Exam- 
inations         213 

••                     "                   Volunteer  Attending  Physi- 
cian         231 

**  "  Women's   Auxiliary   to    the 

Tuberculosis   Clinics    .  . .    236 

Nurses    for    Tbc 233 

Object     of : 196 

"         Patients    (Tubercular) — ^Visits   to 169 

"         Physicians, — ^District  Work   in   Tbc 160 

"         Procedure    in    Tbc 195 

StafE     197 

Collection    of    Laboratory    Specimens 314 

266 

M 


Section 

Ilommittees   for   Relief   in   Tbc.    Clinics 227 

Jommunicable  Diseases, — Requiring  Notification  by 

Institutions     in ^ 4B 

ZIomplaints   of   Suspected   Tbc.    Cases 148 

Complaints, — As  form  of  Notification   of  Infectious 

Disease     38D 

Complement  Fixation  Test  for  Gonorrhoea 269 

Completion    of    Daily    Business 16 

Conferences, — Monthly     22 

Contagious  Disease  Division 48  to     93 

Convalescents — Receiving  Social  Service  after  Con- 
tagious  Disease    81 

Correspondence, — Regulation  for   Officers  as   to....     23 

Cultures, — Outfit  for    289  to  301 

Culture    Stations — See   Directory 2 

Current   Record   File 131 

D 

Daily  Business  to  be  Completed 15 

Daily    Reports    to    and    from    Branch    Office — Tbc. 

Clinics     202 

Daily  Reports  of  District    Nurses    257 

Daily  Reports  of  Field    Workers    27 

Daily  Reports  to  Borough    Office    from   Branch    Of- 
fices           47 

Daily  Reports    and   Time    Record 14 

Date  File  (general)   Contagious  Diseases 43B 

Date  Tally  File  for  Tbc 43F 

Dead  Cases — Tbc 142 

Dead    Tbc.    Cases — Name   File 401 

Deaths  from    Malaria 92 

Death  Certificates     as     Notification     of     Infectious 

Diseases     38G 

Deaths  from  Infectious  Diseases 65 

Deaths  from  Infectious  Diseases,    —    Procedure    in 

Bureau    of    Records 65A 

Deaths    from    Infectious    Diseases, — Duties    of    In- 
vestigators      ^ -650 

Deaths    from    Infectious    Diseases, — Procedures    in 

Infectious  Disease  Bureau 65B 

Deaths  from   Infectious  Diseases, — Regulations  Re- 
garding  bodies   removed   from   city 65D 

Deaths — Reports  required  by  Sanitary  Code 4C 

Deaths — Procedure   in   Clinics   in   cases   of 215 

Delinquent    Cases    of    Tbc 223 

Destruction     of    Glandered     Animals — Required     by 

Sanitary   Code    4R 

267 


Section 
Destruction   of   Rabid   Animals — Required   by    Sani- 
tary Code 4T 

Detention  in  Hospitals  of  Dangerous  Cases 183 

Diagnosis  Laboratory     287  to  317 

Diagnosis  Laboratory — Abbreviations  of  Results  of 

Diphth.   Cultures    291 

*•  "  Antiformin    Method    205 

"  "  Cerebro-Spinal    Meningitis..   313 

"  "  Circulars    of    Information..    288 

"  "  Circular       of       Information 

(Diphth.)     301 

"  "  Circulars      of      Information 

(Typhoid)      311 

"  "  Collection  of  Specimens 314 

Culture    List 295 

Cultures   from    School    Chil- 
dren        296 

"  "  Cultures    from    Department 

Hospitals     298 

"  "  Duties  of  Assistant  Director  287 

"  "  Duties    of    Collectors 316 

"  "  Ehrlich's  Diazo  Reaction, 

309   to  310 
"  *'  Exarhinations     on     Sundays 

and   Holidays    299 

"  "  Examination     for      Malarial 

Organisms    312 

"                      "               Examination      for      Cerebro- 
spinal   Meningitis     313 

"  "  Examination   for   Tbc 303 

"  "  Examination    for    Typhoid..   307 

"  "  General    Procedures    302 

"  "  General    Rules    of 317 

'•  "  Hours    of   Examination 285 

"                     "               Outfits    for    Obtaining    Cul- 
tures (Diphth.)    289 

••                     "               Preparation    and    Examina- 
tion  of  Cultures 290 

••  "  Preparation     of    Diphtheria 

Culture  Media   300 

«•  "  Recording     and      Reporting 

of  Results    294 

«*                     "               Reports    on    Tbc.    Examina- 
tions        306 

"                    "              Routine   Procedure   In   Bor- 
ough  Office   297 

"                    "               Routine   Procedure  in   Lab- 
oratory     286 

268 


Section 

Diagnosis  Laboratory — Scope  of  Work 284 

Sputum  Outfits   303 

"  "  Sterilization  of  Cultures  and 

Storage  of  Slides 293 

"                      "                Stock  of  Supplies  Carried  by- 
Stations    315 

Supply   Stations    314 

"  "  Technic  of  Widal  Reaction,   308 

"  "  Technic  of  Diazo  Reaction.   310 

"  "  Test  for  Virulence 292 

Virulence    Test    (Diphth.) . .   292 

Widal  Reaction   307 

Diagnostic   Clinic, — ^Venereal  Diseases 265 

Diagnosis  not  made  in  Tbc.  cases 145 

Diagnosis. — Visits   of   Hospital   Admis.    Bur.   Physi- 
cians   for 178 

Diazo   Reaction — (Ehrlich's)    for   Typhoid 309  to  311 

Diagnostician, — Borough    51 

Chief    50 

"  District; — Duties     52 

Diphtheria — ^Antitoxin    75 

"  Antitoxin      in      Syringe      Containers, — 

where  sold   76 

"  Carriers     78 

"  Procedures  in    74 

"             Diagnosis    of,    (See    Diagnosis   Labora- 
tory)     288  to  301 

Director's  Duties   26A 

Directory  of  Officers,  Clinics,   Camps,   Laboratories, 

Sanatoria  and  Culture  Stations 2 

Disinfecting  Plants    Ill 

Disinfection — Required  in  Infectious  Diseases 40 

Disinfection  of   Stables   after  Glanders 279 

Disinfection  in  Typhoid  Fever 249 

Disinfection, —  Requests   for    94  to  95 

"  Diseases  in  which  it  is  performed...      96 

of  Books    97 

Methods    98 

"  Tests    99 

Disinfector's  Duties    100 

Dlsinfector-in-Charge,  Duties   101 

District  Nurses     254 

Outfit     255 

«•  "  Duties 256 

"  "  Daily   Report    257 

"  "  Weekly    Report    258 

"  "  Duties   in   Clinics 164 

269 


Section 

District  Work  of  Clinic  Physician 166 

"         Diagnostician, — Duties     52 

Division  of  Contagious  Diseases 48,  93  incl. 

"                        "                   "         Scope  of  its  Super- 
vision          49 

Institution    Inspection 115,  126 

"  "  Functions     115 

Chiefs    of 120 

Typhoid  Fever   238 

Chiefs  of   239 

Tuberculosis     127 

Venereal  and  Veterinary  Diseases 259 

Drivers  of  Goods  Wagons, — Rules  for 113 

Duties  of  Ambulance  Drivers    107 

"        "    Assistant  Director,  Diagnosis  Laboratory.  287 

"    Borough  Chiefs   26C 

"        "    Collector  of  Laboratory  Specimens 315 

"        "    Chief  of  Institution  Inspection 121 

"    Chiefs  of  Divisions 26B 

••    Chief   Clerks    32 

"    Director    26A 

"    Disinfectors     200 

"        "  "  -in-charge  of  Stables 112 

"        "    District  Nurses  in  Clinics 164 

"        "    District  Nurses  in  Field 256 

"        "    Foreman-in-charge   of   Stables 108 

"        "    Goods   Wagon   Drivers 102 

Duties — General — (For   Officers)    25 

Duty — Hours  of 13 

Duties  of  Investigator  in  deaths  from  Contag.  Dis- 
eases        65C 

Duties  of  Institution   Inspectors    126 

"         "    Physicians-in-charge    26D 

Duties — Special   (For  Officers) 26 

"  of   Stablemen    315 


Education  of  Public  &  Charitable  Ass't.  in  Contag. 

Diseases 62 

Efficiency   Ratings    36 

Eggs   and   Milk, — Tbc,   Clinics 221 

Ehrlich's   Diazo    Reaction 309,  311 

Employees, — Regulations  Applying  to  All 5  to  21 

"  Examinations  of  New 6 

Enforced  Removals  in  Contag.  Diseases 63 

Envelope  Name  File, — Tuberculosis 43C 

"  "         "  "       Discontinued  Cases.  43F 


270 


Section 

'Enforced  Removals  in  Tbc.  Cases 160 

Jrysipelas — Procedures   in    91,  93 

Ixamination  at  Hospital  Admission  Bureau 177 

Ixamination  for  Gonococci — Smears  270 

"     Treponema  Pallidum    272 

"     Malarial  Organism    312 

of    Peddlers    for    License 211 

"     Urine  and   Sputum 213 

"     Rooms, — Procedure     216 

"     Throats  in   Tbc.   Clinics 221 

"     Diphtheria   Cultures    290 

"     Diphtheria     Cultures     on     Sundays 

and  Holidays   299 

"     Sputum     303   to  306 

"     Bakers  at  Clinics 210 

"     New  Employees    6 

Ixclusion  from  School     4 J 

"  "  "       in  Contag-.  Diseases 67 

Ixecutive  Office, — Routine  Procedures  in 32,  36 

-      "  "  Reports   33 

)xpress  Service  of  the  Department 114 


'ees  Forbidden    8 

"leld  Workers, — Regulations     27,  31 

"  Daily   Reports    27 

'ile — Card  Name,    (Tuberculosis) 40E 

(Date) — for  Tbc.   Cases 43E 

"        Envelope, — Names      of      Discontinued      Tbc. 

Cases    43F 

"        Envelope, — Names  of  Tbc.   Cases 43C 

"       General  of  Name,  of  Active  Contag.  Cases. 

40A-43A 

"        General  of  Date  of  Contagious  Cases 43B 

"        (House), — Contagious     40B 

(House),   Tbc 43D 

"        Laboratory — Diphtheria    40C 

"  "  Typhoid    40D 

"        Names  of  Terminated  Cases   (Contagious)  .  . .   40F 

Names  of  Dead  Tbc.  Cases 401 

Not  Found   (Tbc.) 40H 

"        Postal  Address  in  Minor  Contagious  Cases...    40G 

Tally    (For   Branch    Office) 45 

Mling  Bureau — Central    24 

Histories    in    Tbc.    Clinics 207 

"Inal  Diagnoses — Later  Examinations 225 

■"orbidding  Fees    8 


271 


Sectio] 

Forcible  Removal  of  Tbc.  Cases 16i 

"  "     Contagious   Cases    6 

Foreman-in-charge  of  Stables — Duties   10 

Forms  Employed  in   Bureau 323-32 

Forwarding  Reports  of  Tbc.  Clincs 20 

Function  of  Bureau  of  Infect.  Diseases 

Functions  of  Division  of  Institution  Inspections...   11 
Funerals    (private), — Required    in    Infectious    Dis- 
eases       4]y 

Furniture,  Signs  and  Maps  of  Clinics,  etc .'..'.*  20 


General  Duties  of  Officers   2| 

"         Instructions  for  Nurses 6l 

"         Name  File  of  Active  Contagious  Cases 

40A  and  iZI 

"         Procedures, — Infectious  Diseases   37,  4! 

"         Routine, — Tbc 13! 

German  Measles, — Procedure  in 84,  81 

Glanders, — ^Disinfection   of   Stables 27! 

"  Investigation  of   271 

"  Procedure  in 90  and  27( 

"  Registration  in    27' 

"  Requiring  Notification   of 4<; 

"  "  Destruction  of  Animals 41 

271 

Gonorrhoea, — Complement  Fixation  Test  for 26J 

Gonococcus, — Smear  Examination   for 27( 

Goods-Wagon  Drivers — Duties    lOi 

Rules  for   Hi 


History  Cards  in  Tbc 16E 

Taking  in  Tbc.   Clinics 20t 

"         Filing  In  Tbc.  Clinics 201 

Health    Department, — Tbc.    Institutions 188 

Home  Conditions  of   Riverside    Cases 184 

"  "  after  Admission  to  Hospital 181 

"        Cases   of  Tbc 141 

"        Investigations    and    Financial    Condition    Be- 
fore Admission  to  Hospital 17S 

Homes, — Nurses'  Work  in  Tbc.  Cases  in  the 163 

Home  Visits  by  Clinic   Physicians 228 

"    Tbc.    Clinic   Nurses 222 

Horses — Requiring  Tagging  of  Dead 4S 

272 


Section 
lospital   Admission   Bureau,— Admission   to   Hospi- 
tal       180 

««                  "                   •'            Application    for    Ad- 
mission       176 

«  "  "  Application  for  Sana- 

torium  Treatment.  185 
«•  "  "  Care  of  Tbc.  Patients 

of  Department   . . .   173 

•«  «•  "  Examination    at 177 

.«  "  "  Institutions      Admit- 

ting Patients  thro'  174 
«  "  "  Investigation  o  f 

Home    and    Finan- 
cial  Condition 179 

«                  "                   "            System    of    Registra- 
tion       176 

i<  «•  "  Visits  by  Physicians 

for  Diagnosis  ....    178 

"  Care, — Recommendations    for 212 

Cases    (Tbc.   Case) 152 

Cultures  from  Departmental ^»» 

Detention  of  Dangerous  Cases 183 

Quarantine  in  Infect.  Diseases  Cases  in...   119 

Removal  to    ^^ 

"  Tbc.  Cases  Admitted  to ^^^ 

otels    and    Lodging    Houses— Requiring    Notifica-    ^^ 

tion  by   -  „ 

Hours   of  Duty    .^„ 

House  File, — Contagious  Diseases   *"^ 

«  ««         Tbo      ***"^ 

_  ■'•"^ 280 

Hydrophobia    

I 

Institutions,— Admitting  Patients  Through  Hospital 

Admission   Bureau    i^* 

Inspector  of f^! 

Inspection — Assignment   of  Cases i^o 

Inspection   115  to  126 

"                Inspectors— Duties    J^J 

"                Isolation   in    tl' 

Notification  in  Infectious  Diseases...  1^^ 

Office  of  Chief  of  Division 121 

"                 Quarantine  in    11^ 

Registration  of  Contag.  Dis.   in 1^3 

Removal  to  Hospitals  from 118 

Report  regarding  their  Tbc.  patients.  182 

273 


Section 
Institutions, — Required  to  Give  Notification  of  Com- 
municable and  Parasitic  Diseases, 

4B,   38B 

"  Requiring    Tbc.    Reports   of 4F 

"  Requiring  Isolation  Facilities 4K 

"                 Regulations  for  Management  of  Infec- 
tious Diseases  in    116 

Interpretation  of  Wassermann  Test  for  Syphilis.  .  .    268 

Investigation  of  Milk  Stores  for  Typhoid 245 

*'  "    Typhoid  by  Inspectors 246 

in   Glanders    278 

"  in   Rabies    282 

"  of   Home   and   Financial   Condition  in 

Tbc.   Cases    179 

Isolation  Facilities   Required  in   Institutions 4K 

"  in  Institutions    117 

E 

Knowledge  of  Regulations  Required  of  Employees..     21 

I. 

Laboratory  File  for  Diphtheria" 40C 

"     Typhoid    40D 

Diagnosis     287-317 

Serological     266 

Later  Examinations  in  Tbc.  Clinics 225 

Laymen, — Requiring   Notification   by 4E 

Leave, — Sickness    10 

Leaving    City    Temporarily    to    Enter    Sanatorium 

(Tbc.   Cases)    139 

Leaving    City    Permanently    to    Enter    Sanatorium 

(Tbc.  Cases)    144 

Leprosy — Procedure  in    90 

Liquid  Disinfectants    98 

Lists,  Diphtheria   Culture    295 

of   Publications    323 

Living  in  other  Boroughs   (Tbc.  Cases) 147 

Lodging  Houses  and  Hotels,  Requiring  Notifications 

by    4D 

Lodging  House  Patients   (Tbc),  Visits  to 168 

M 

Malaria — Deaths  from    92 

Malarial  Fever    91 

"  Organism, — Examination     312 

Mapping  of  Typhoid  Cases 242 

Measles — Procedures  in   80 

274 


Section 

Media — Preparation  of  Culture 300 

Medical  Adviser — Venereal  Diseases    264 

Medicines  in  Tbc.  Clinics 270 

Meningitis — Examination   for   Cerebro-Spinal 313 

Methods  of  Disinfection 98 

"Middletown" — The     191 

Milk  and  Eggs, — Tbc.  Clinics 229 

Milk  Store  Investigation  in  Typhoid 245 

Minor  Contagious  Diseases — Postal  Address  File. . .  40G 

Monthly  Census  in  Tbc 133 

Monthly  Conferences    22 

Moving  Pictures  and  Stereopticon  Exhibitions 172 

Mumps — Procedures  in   86 

N 

Name-File — Active    Contagious    Cases 40A-43A 

"      Cards  for  Tbc 40E 

"      Dead    Cases   Tbc 401 

"      Envelope  for  Tbc 43C 

"  "      Terminated  Cases   40E 

New  Cases  of  Tbc.  Reported  by  Clinics 214 

"  "        Search    for    28 

'•      Employees   Examined    6 

Non-Department.     Tbc.     Cases — Reports     by     other 

Clinics     137 

Non-Tbc.   Applicants   to   Clinics 209 

Notification  of  Absence    11 

"  Complaints    Charity    Organizations 38E 

"  of  Glanders  required 4 A 

"  by  Hotels  and  Lodging  Houses 4D 

"  by     Institutions      (Communicable     and 

Parasitic    Diseases)     4B 

"  of    Infectious    Diseases    by    Physicians 

(Sanitary   Code)    4A 

"  of  Infectious   Diseases 38 

"  by  Laymen    4E 

"             by    Private    Physician    in    Death    Cer- 
tificate   38C 

"  and    Registration — Typhoid    243,  244 

•*  and    Registration — Tuberculosis 129 

"             and    Registration    of    Contagious    Dis- 
eases          57 

"             in    Institution    Cases    (Infectious    Dis- 
eases)         122 

for    Glanders    276 

for    Rabies    281 


Section 

"Not  Found"  at  Address  given  (Tbc.  Cases) 140 

"  "         Cases    (Contagious   Diseases) 66 

File  Tbc 40H 

Nurses,  Clinic  and  Registration 253 

(District)     254 

"  "  Daily  Report   257 

"  "  Duties     256 

"  "  "         in  Clinics  for  Tbc 164 

Outfit    255 

"  "  Weekly    Report    258 

"  Home  Visits   by   Clinic  Nurses 222 

"  Instruction — Contagious    Diseases 53-54-55 

"  Instruction-Contagious    Diseases — Special.     56 

"  Supervising    252 

"  Tbc.   Camps    193 

"  of  Tbc.   Clinics 233 

"  Work  in  Homes — Tbc.   Cases 163 

Nursing — Division   of    (Superintendent) 251 

O 

"Observation  Cases" — Contagious   59B 

Office    (Borough) — General   Procedure   In   Infectious 

Diseases    37 

Office  of  C::hief  of  Division  of  Institutions 121 

"        "    Division  of  Institution   Inspection 124 

"    Supplies    34 

Officers, — Regulations  Applying  to  All 22  to  26  inc. 

Offices — Borough   and  Branch — See  Directory 2 

Organization  of  Bureau  of  Infectious  Diseases 3 

"    Clinics     199 

"              "    Tbc.  Division    128 

Otisville  Sanatorium     189 

Otisville  Sanatorium, — Applicant's  Instructions  ....  190 

Outfit  for  Diphtheria  Culture 289 

"       of  District  Nurses 255 

Outside  (non-Departmental)  Clinic  Cases  Tbc 137 

F 

Paraformaldehyde  Disinfection    98 

Parasitic  Diseases — Requiring  Notification  by  Insti- 
tution         4B 

Patients  Admitted  to  Institutions  Through  Hospital 

Admitting    Bureau    174 

Peddlers  Examined  for  License 211 

Permits  to  Return  to  School — in  Contag.  Diseases..     68 


276 


fl 


Section 

Physicians   (Attending  Clinics) — Rules    230 

"  in  Charge, — Duties   26D 

"       "  of  Tbc.   Clinics   198 

"  of  Clinic — ^District  Work 166 

"  of  Tbc.  Clinics — Home  Visits 228 

"  (Volunteer)    Clinics    231 

Pictures. — Moving  and  Stereopticon  Views  in  Tbc  .    172 

Placarding  Contagious  Cases 60 

Placards  for  Tbc 157 

Plague, — Procedures    in 72 

Plants — Disinfecting    Ill 

Pneumonia, — Procedure    in 91 

Postal  Address  File  for  Minor  Contag.  Diseases....  40G 

Premises  Required  to  be  Renovated 4P 

Preparation  and  Examination  of  Diphtheria  Cultures  290 

Prevention — Tbc.  for  Children 187 

Private  Funerals  Required  in  Infectious  Diseases. .     4M 
"         Physicians — Notification   in   Infectious  Dis- 
eases     38A 

"         Physicians — Tbc.    Cases 136 

Probation  Period 7 

Procedure  at  Branch  OflSce — Tbc 130 

"  (General)    in   Infectious   Diseases 37-47 

"  (General)   in  Rabies 280 

"           in   Borough    Office   with   Diphtheria   Cul- 
tures        297 

"  in    Bureau    of     Infectious     Diseases     in 

Deaths     65B 

"           in  Bureau  of  Records  in  Deaths  from  In- 
fectious Diseases 65A 

"  In  Laboratory  Examination    302 

"  Routine  of  Clinics 203 

"  In   Cerebro   Spinal   Meningitis 82 

"  in   Chicken   Pox    87 

"  In  Cholera-Plague,  Yellow  Fever 72 

Procedures  in  Diphtheria    74 

"  in   German   Measles 85 

"  in  German  Measles,  Mumps,  Chicken  Pox 

and  Whooping  Cough 84 

"  in  Measles   80 

"  in   Mumps    86 

"  in    Pneumonia    91 

"  In  Poliomyelitis  Acute    83 

Scarlet  Fever   79 

Small  Pox   70 

"  Typhus   Fever    73 

"  Whooping  Cough   88-89 

Prohibiting  Removal  of  Case 41 

277 


SiJCTIONf 

Promotion    of  Volunteers    232 

Property — Care  of  Departmental 18 

Public    Information    16 

in  Tbc. — Regarding  Supervision  171 
Publications,    Forms,    &c .323-324 

Q 

Quacks — Venereal   Advertising    by 273 

Quarantine  in  Contagious  Cases 61 

"  in  Contagious  Cases  in  Institutions  and 

Hospitals   119 

"            in  Typhoid   250 

B 

Rabid  Animals — Authorizing  Destruction  of 4T 

Rabies,  Clinics  for  Administering  Anti-Rabic  Treat- 
ment       283 

"        General  Procedure   280 

"        Investigation     282 

"        Notification     281 

Ratings    36 

Recommendations  for  Charitable  Aid  in   Tbc 150 

"     Hospital         "       "       " 151 

Care     212 

Records — Blanks,   etc 35 

"  of  Infectious  Diseases  at  Branch  Office.. 41-43 

"     Borough     "     ..     40 

Recovered  Cases — Tbc 143 

Information    to    Public 171 

Registration  and  Notification  of  Contag.  Diseases..     57 

"  and  Notification  in  Tbc 129 

"  System  at  Branch    Ofl[ice 42 

"  System  at  Hospital  Admission  Bureau  176 

"  of  Venereal  Diseases 262 

Regulations  Applying  to   all  Employees 5-21  incL 

for  Field  Workers 27-31 

"  ,.  for  Glanders 277 

"  of  Tbc.  Camps   194 

"  for    Management   of   Contag.    Diseases 

in    Institutions    116 

"  in   Institution   of   Cases   of  Infectious 

Diseases   128 

Relief   Committee — Tbc.    Clinics    227 

Removals — Enforced    in    Contagious   Diseases 63 

Forcible — of  Tbc.  Cases 160 

Removal  of  Bodies  from  City  in  Deaths  fi-om  Con- 
tagious  Diseases    65D 

278 


Section 

iRemoval  of  Cases — Prohibited   41 

"           of  Patients   in  Ambulance    105 

"          of    Tenants — Requiring    Reports    of 4G 

"           to   Hospitals — Authorized    4H 

"          to   Hospitals   from    Institutions 118 

Renovation    after    Tbc 155 

"              of   Premises,    Authorized    4P 

Voluntary  in   Tbc 158 

Reporting    and    Recording    Result     of     Culture     for 

Diphtheria    294 

New  Cases  of  Tbc 214 

Reports — Executive   Office    33 

"  from    Institutions    Regarding    their    Tbc. 

Patients    182 

"          of   clinics — Forwarding   of    201 

"           of    clinics    to    Headquarters 203 

"          of  Death — Required  by  Sanitary  Code....  4C 

"          of  Tbc,  Required  by  Institutions 4P 

(Weekly)  in  Tally  Sheets — Branch  Office..  46 

Requests  for  Disinfection    95 

Riverside    Cases — Home    Conditions 184 

Routine — General,  in  Tbc 132 

Routine  Procedure  in  Executive  Office 32-36 

Routine  Procedure  in  Camps 192 

Routine  Procedure  of  Clinics 205 

Rules  for  Attending  Physicians 230 

"       for   Clinic    Nurses 234 

"       General,  for  Diagnosis  Laboratory 317 

"       for  Goods  Wagon  Drivers 113 

'Rutherford,"   The    191 

S 

Sanatoria — See    Directory     2 

"  Applicants    185 

"  Cases  of  Tbc.  leaving  City  temporarily.   139 

Sanatorium,    Otisville    189 

Sanitary  Code,   Authorization 4 

Violation 19 

"         Supervision  of  Contagious  Diseases 58-60 

of  Tbc 153 

Scarlet  Fever,   Procedures  in 79 

School  Children,  Cultures  from 296 

School    Children,    Tbc.    Cases 146 

School    Exclusion     4 J 

"  "  in   Contagious   Diseases    67 

Schools  (Fresh  Air)   «&  Tbc.  Camps 191 

"         Permits    Allowing    Return     in    Contagious 

Diseases    68 

279 


Suction 

Scrubbing  of  Floors  in  Tbc 156 

Scrubwomen    &    Cleaners 159 

Search  for  New  Cases  by  Field  Workers 28 

Serological  Diagnosis    266 

Sick  Leave    10 

Signs  on  Vehicles   106 

Smallpox,  Procedures  in   69-71 

Smoking    20 

Social    Service    among    Contagious    Disease    Conva- 
lescents         81 

Special  Duties    26 

Sputum  and  Urine  Specimen  in  Tbc 213 

•'         Examination — Tbc 303-306 

Stablemen,  Duties 109 

Stables    103 

"         Disinfected    after    Glanders    279 

"         Disinfector-in-Charge     112 

"         Foreman-in-Charge,  Duties    108 

Staff  of  Bureau  of  Infectious  Diseases,  Its  Organi- 
zation           3 

"    Clinics    Tbc 197 

Statistics,   Tabulation  of  Tbc 204 

Sterilization  of  Culture    293 

Storage  of  Culture  Slides    293 

Study  of  Tbc.  Cases    224 

Superintendent  of  Nursing   251 

Supervising  Nurses    252 

Supervision    Cases,    Contagious 59A 

"              of  Tbc.   Cases  at  Home   (General  Pro- 
cedure)        161 

Supplies  in   Stations    315 

Supplies,    Office   of 34 

Supply    Stations    314 

Suspected   Tbc,   Cases  and  Complaints 148 

Symbols  Used  for  Reporting  Examination  of  Gono- 

cocci   Smears    271 

Syphilis,   Wassermann   Test   for 267 

T 

Tabulation  of  Statistics  in  Tbc 204 

Tagging  of  Dead  Horses  Required 46 

Tally  Files,  General  Date   (Contagious) 43B 

Date    (Tbc.)    43B 

'•  "       Branch   Office   45 

"       Sheets,  "Weekly  Reports  of  Branch  Office 46 

Technic   of  Widal    Reactions 308 

Telephone  Regulations    17 

"  and  Carfare  Bills   21 


280 


i 


Section 

Temporary   Appointments    5 

Tenants,  Requiring  Report  of   4G 

Termination   of   Contagious   Cases    64 

Tests   for  Disinfection 99 

Test  for  Virulence  of  Diphtheria  Bacilli   292 

Tetanus,   Procedure   in    90 

Throat   Examinations    221 

Time   Records    14 

Treponema  Pallidum,  Examination  for 272 

Trichinosis,   Procedure   in    90 

Tuberculosis — 

Admission  to  Hospital    180 

Application   for  Admission   to   Institution 175 

Applicants  for  License  to  Peddle 211 

"           Living  in  Other  Clinic  Districts. . . .  208 
Appointment    and    Promotion    of  Volunteer   At- 
tending  Physician    232 

"At  Home"   cases    141 

Association  of  Tbc.  Clinics  of  the  Dept 231 

Bureau  of  Information  of  Hosp.  Adm.  Bureau.  .  186 

Camp    Regulations     164 

Camp  Nurses    193 

Camps  and  Fresh  Air  Schools 191 

Card    Name    File    40E 

Care  of  Cases  During  Hospital   Stay 152 

Care  of  Dept.  Cases  at  Hosp.  Admission  Bureau  173 
Cases  Leaving  City  Temporarily  to  enter  Sana- 
torium      139 

Cases  Leaving  City  Permanently  to  enter  Sana- 
torium      144 

Cases  of  Recovered  Tbc 143 

Cases  of  Dead  Tbc 142 

Cases  of  Tbc.  not  found  at  address  given 140 

Cases  "At  Home"   141 

Cases  Undiagnosed  145 

Cases  in   School   Children    146 

Cases  Living  In   Other  Boroughs 147 

Cases   Suspected   or  Complained   of 148 

Cases  for  Charitable  Aid 150 

Cases  for  Hospital  Aid 151 

Cases   "Dead-Name  File"    401 

Charitable  Aid    150-226 

Circular  of  Information   235 

Circular   of   Instruction    162 

Classification  of  Cases    135 

Clinic  Staff   197 

Clinic  Relief  Committees   227 

281 


Skction 

Clinic  Nurses   233 

Clinics     195 

Confirmatory  Re-examinations   218 

Current   Record  File    131 

Daily  Reports   to   and   from  Branch   Offices....  202 

Date  Tally  File   43B 

Dead  Cases   142 

Deaths    215 

Delinquent   Cases    223 

Detention  in  Hospital  of  Dangerous  Cases 183 

Diagnosis — Final 225 

District  Work  of  Clinic  Physicians 166 

District  Nurses  in  Clinics,  Duties 164 

Division    127 

Envelope  Name  File 43F 

Envelope  Name  File 43C 

Examination     of    Bakers 120 

Examination  at  Hospital  Admission  Bureau 177 

Final  Diagnosis — Later  Examination 225 

Forcible  Removal    160 

Forwarding   of   Reports    201 

Fresh    Air   Schools    and   Camps 191 

Furniture,    Signs,    Maps,    «§:C 200 

General    Routine     132 

History   Cards    165 

Home  Visits  by  Nurses 222 

Home  Visits  by  Clinic  Physicians 228 

Home  Conditions  of  Riverside  Cases   184 

Home  Conditions  after  admission 181 

House   File   for   Tbc 43D 

Hospital   Admission   Bureau    134 

Instruction    in    History   Taking 206 

Instruction    of   Patients    (Circular) 219 

Instructions  for  Applicants — Hosp.  Adm.  Bureau  190 
Institutions   Maintained   by   the  Department   of 

Health    188 

Institutions    Admitting    Patients    through    Hos- 
pital  Adm.   Bureau 174 

Investigation  of  Home  and  Financial  Conditions  179 

Kinds  of  Disinfection  after  Tbc 154 

Medicines   in    Clinics 220 

Milk    and    Eggs 229 

Monthly    Census    133 

Moving  Pictures  and   Stereopticons 172 

Non-Tuberculous   Applicants   at   Clinics 209 

Not  found  at  address  given,  Tbc.  cases 140 

Not  Found  File   40H 

282 


Section 

Notification   and   Registration    129 

Nurses'   Work  in   Homes 163 

Objects  of  Establishing  Clinics 196 

Organization   of   Clinics 199 

Otlsville    Sanatorium     189 

Physicians-in-charge    of   Clinics    198 

Placards    157 

Preventorium    for    Children    187 

Procedure   at   Branch    Offices 130 

Procedure  in  Examination  Rooms  of  Clinics....  216 

Private  Phj^sicians'  Cases   136 

Recommendations    for    Hospital    Care 212 

Recovered  Cases  of  Tbc 143 

Recovered  Cases  of  Tbc 170 

Renovations   155 

Renovations,   "Voluntary    158 

Reported  by  Non-Dept.   Tbc.  Clinics 137 

Reports   to   Headquarters    from   Clinics 203 

Reporting  New  Cases 214 

Reports  from   Institutions  Regarding  their  Pa- 
tients    182 

Requiring  Reports  of  Institutions  in  Tbc 4F 

Routine  Procedure  at  Clinics 205 

Routine  Procedure  at  Camps 192 

Rules   for  Attending  Physicians   at   Clinics....  231 

Rules    for    Clinic    Nurses 234 

Sanatorium    Applicants     185 

Sanitary  Supervision   153 

School   Children   with   Tbc 146 

Scrubbing   of   Floors 156 

Scrubwomen    and    Cleaners 159 

Sputum  Examination — Antiformin   Method 305 

Sputum    Examination    Outfits 303-304 

Sputum    and    Urine    Specimens 213 

Suspected  or  Complaint  Cases    148 

Supervision    at    homes — General    Procedure....  161 

Study   of   Cases   in   Clinics 224 

System  of  Registration  at  Hosp.  Adm.  Bur 176 

System    of   Abbreviations    217 

System  of  Filing  Histories 207 

Throat  Examinations  in   Clinics 221 

Undiagnosed    Cases    145 

Visits  to  Lodging  House  Patients   168 

Visits  to  Clinic  Patients    169 

Visits   by   Physician    for  Diagnosis 178 

Voluntary  Renovation    158 

Volunteer    Attending    Physicians — Appointment 

and  Promotion   232 

283 


Section 
Women's  Auxiliary   to   the  Tbc.   Clinics   of  the 

Dept 236 

Tuberculous   Children    167 

Typhoid  Charts   241 

Typhoid  Fever,  Disinfection  in 249 

Division     238 

Division — Chief   of    239 

Division,    Office    of 240 

Immunization    247 

Instructions    (Special)    for   Typhoid 

Inspectors    248 

Investigation  of   Cases  by  Typhoid 

Inspector   246 

Investigation  of  Milk  Stores 245 

Laboratory   File   for i . . . .  40C 

Mapping  of  Cases  in 242 

Notification   and   Registration 243 

Notification  at  Borough  Office 243 

Notification   at   Branch    Office 244 

Quarantine     250 

Typhus   Fever,    Procedure   in 73 


Undiagnosed    Tbc.    Cases 145 

Urine,   Specimen   in  Tbc 213 


Vacations     12 

Vehicle    Signs    106 

Venereal  Diseases,  Circular  of  Information 274 

Chief  of   260 

"  "  Diagnostic   Clinics    265 

"  "  Division    of    259 

"  "  Gonorrhoea,  Complement  Fixa- 
tion Test    269 

"  "  Inspection  of  Cases 263 

"  Medical   Adviser    264 

"  Registration     262 

"  "  Serological  Diseases    266 

"  "  Smear    Examination    for    Gono- 

cocci    270 

"  "  Smear  Examination  for  Gono- 
cocci,  Symbols  Used  for  re- 
porting       271 

"  "  Wassermann  Test  for  Syphilis..    267 

"  "  Wassermann    Test    for    Syphilis 

Interpretation     268 


284 


Section 
A^enereal   Diseases,    Treponema   Pallidum    EJxamina- 

tion     272 

"            Quacks,    Advertising    273 

Veterinary  Diseases,   Division   of 259 

Violation  of  Sanitary  Code 19 

Virulence    Test   for   Cultures — ^Diphtheria 292 

Visits    by    Physicians   for    Diagnosis 178 

Visits    to    Clinic    Patients    in    Tbc 109 

Visits  to  Lodging  House  Patients  in  Tbc 168 

Volunteer  Attending  Physicians    231 

W 

I  Wagon    Service    110 

'Wassermann  Test  for  Syphilis 267 

■Wassermann  Test  for  Syphilis  Interpretations 268 

Weekly   Reports — Tally    Sheets 46 

Whooping    Cough,    Procedures    in 88-89 

Widal   Reaction   for  Typhoid    307-308 

Women's  Auxiliary  to   Tbc,   Clinics 236 

T 

Yellow   Fever,    Procedures    in    72 


285 


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